Faculty Bibliography

BACKGROUND:Pediatric professionals promote shared reading to facilitate school readiness yet relatively few studies examine how parents from underserved communities consider this issue in their daily lives. We sought to understand shared reading within the broader context of parenting among Latino parents. METHODS:We conducted in-depth interviews, purposively sampling Spanish-speaking, Latina mothers of children age ≤ 3 years from an urban Federally Qualified Health Center. Interviews were recorded, transcribed, and analyzed iteratively. We allowed themes to emerge from data rather than impose an a priori framework. We sought disconfirming evidence within interviews and collected additional data to ensure no new themes were identified (saturation). RESULTS:We achieved saturation after 12 interviews. The median child age was 1.4 years. We identified 4 major themes: (1) All participants reported engaging in literacy promoting activities such as conversations, storytelling, play, and singing even if they did not read to their children daily. (2) Parents' attitudes regarding early learning and development influenced the extent to which parents engaged in shared reading with their child. (3) Participants described feelings that they ought to read daily with their children but were not and cited a variety of barriers. (4) Parents who engaged in frequent shared reading described it as a joyful and relaxed experience; parents who did not engage in shared reading described reading as instructing children or engaging in drills (e.g. teaching letters). CONCLUSION/CONCLUSIONS:Urban, Latina mothers who did not read regularly with their children nonetheless recognized its importance suggesting that existing programs have raised awareness even among underserved families. Refinement of messaging may be needed to move past raising awareness to facilitating shared reading for some parents.

Attendance at well-child visits (WCVs) is a sine qua non of preventive care. We hypothesized that Reach Out and Read (ROR) would be associated with better WCV attendance. Parents of children 76 to 72 months at 8 clinics who did not yet have ROR reported how many WCVs their child had attended in the previous year; separate samples at the same clinics were interviewed 16 months after the ROR program was instituted. Comparing 267 parents before ROR and 254 after, the percentage who had attended the minimum number of WCVs required by the American Academy of Pediatrics periodicity schedule rose from 67.4% (180/267) to 78.3% (199/254; P < .01). This difference remained significant after controlling for multiple potential confounding factors (estimated odds ratio = 2.1, 95% confidence interval = 1.3-3.5). The largest differences were among Latino children and children of less-educated parents. Programs to enhance early literacy may increase attendance at WCVs among at-risk families.

The authors examined children's access to books in 153 four-year-olds from low-income, U.S. ethnic-minority families. Mothers reported on the number of books available to their children and the variety of books their children had, such as concept books about letters, numbers, and shapes and narrative books about cultural beliefs and relationships. Mothers also reported on the frequency of mother"child book-sharing interactions. The authors coded characteristics of book-sharing interactions from videos of mother"child sharing of a wordless book. Most children had a variety of concept books but few narrative books. Children who were later born and who had English-speaking (vs. Spanish-speaking) parents had a greater variety of narrative books than did their counterparts, and children living with their father and mother had a greater variety of narrative and concept books than those who did not reside with their father. The variety of narrative books predicted children's narrative contributions during book sharing through the mediator of mothers" questions about the story. In contrast, the variety of concept books predicted children's referential contributions (e.g., "That's a tree") through the mediator of mothers" referential questions (e.g., "What's that?"). Household composition, home language use, and the content of books shape the early literacy experiences of children from low-income, ethnic-minority families.

The NIH-funded SAFE Rx for Kids study has identified best practices for the labeling/dosing of pediatric liquid medications. Findings support use of pictographic instructions and optimized provision of dosing tools, along with careful selection of the unit of measurement used.

Play is essential to optimal child development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. It also offers an ideal and significant opportunity for parents and other caregivers to engage fully with children using toys as an instrument of play and interaction. The evolution of societal perceptions of toys from children's playthings to critical facilitators of early brain and child development has challenged caregivers in deciding which toys are most appropriate for their children. This clinical report strives to provide pediatric health care providers with evidence-based information that can be used to support caregivers as they choose toys for their children. The report highlights the broad definition of a toy; consideration of potential benefits and possible harmful effects of toy choices on child development; and the promotion of positive caregiving and development when toys are used to engage caregivers in play-based interactions with their children that are rich in language, pretending, problem-solving, and creativity. The report aims to address the evolving replacement of more traditional toys with digital media-based virtual "toys" and the lack of evidence for similar benefits in child development. Furthermore, this report briefly addresses the role of toys in advertising and/or incentive programs and aims to bring awareness regarding safety and health hazards associated with toy availability and accessibility in public settings, including some health care settings.

Background: The burden of mental, neurological, and substance (MNS) disorders is greater in low- and middle-income countries (LMICs). The rapid growth of digital health (i.e., eHealth) approaches offer new solutions for transforming pediatric mental health services and have the potential to address multiple resource and system barriers. However, little work has been done in applying eHealth to promote young children's mental health in LMICs. It is also not clear how eHealth has been and might be applied to translating existing evidence-based practices/strategies (EBPs) to enable broader access to child mental health interventions and services. Methods: A scoping review was conducted to summarize current eHealth applications and evidence in child mental health. The review focuses on 1) providing an overview of existing eHealth applications, research methods, and effectiveness evidence in child mental health promotion (focused on children of 0-12 years of age) across diverse service contexts; and 2) drawing lessons learned from the existing research about eHealth design strategies and usability data in order to inform future eHealth design in LMICs. Results: Thirty-two (32) articles fitting our inclusion criteria were reviewed. The child mental health eHealth studies were grouped into three areas: i) eHealth interventions targeting families that promote child and family wellbeing; ii) eHealth for improving school mental health services (e.g., promote school staff's knowledge and management skills); and iii) eHealth for improving behavioral health care in the pediatric care system (e.g., promote use of integrated patient-portal and electronic decision support systems). Most eHealth studies have reported positive impacts. Although most pediatric eHealth studies were conducted in high-income countries, many eHealth design strategies can be adapted and modified to fit LMIC contexts. Most user-engagement strategies identified from high-income countries are also relevant for populations in LMICs. Conclusions: This review synthesizes patterns of eHealth use across a spectrum of individual/family and system level of eHealth interventions that can be applied to promote child mental health and strengthen mental health service systems. This review also summarizes critical lessons to guide future eHealth design and delivery models in LMICs. However, more research in testing combinations of eHealth strategies in LMICs is needed.

Food insecurity, or the limited access to food, has been associated with maternal child feeding styles and practices. While studies in other parenting domains suggest differential and additive impacts of poverty-associated stressors during pregnancy and infancy, few studies have assessed relations between food insecurity during these sensitive times and maternal infant feeding styles and practices. This study sought to analyze these relations in low-income Hispanic mother-infant pairs enrolled in a randomized controlled trial of an early obesity prevention program (Starting Early). Food insecurity was measured prenatally and during infancy at 10 months. Food insecurity timing was categorized as never, prenatal only, infancy only, or both. Regression analyses were used to determine relations between food insecurity timing and styles and practices at 10 months, using never experiencing food insecurity as the reference, adjusting for family characteristics and material hardships. 412 mother-infant pairs completed 10-month assessments. Prolonged food insecurity during both periods was associated with greater pressuring, indulgent and laissez-faire styles compared to never experiencing food insecurity. Prenatal food insecurity was associated with less vegetable and more juice intake. If food insecurity is identified during pregnancy, interventions to prevent food insecurity from persisting into infancy may mitigate the development of obesity-promoting feeding styles and practices.