Faculty Bibliography

Although it is known that caregiver dietary behaviors influence child eating patterns, a gap remains in addressing the diet of a caregiver as much as their child in pediatric practice. A dyadic (caregiver-child) dietary approach would enhance the promotion of healthy eating patterns in children (and their caregivers) and achieve the population health goal of healthy eating across demographic groups. This study aimed to understand factors influencing dyadic dietary patterns (concordance, discordance) and contexts. Twenty professionals who provide nutrition-related expertise for families were recruited via maximum variation sampling. Qualitative thematic analysis of semi-structured interviews revealed 3 themes: (1) variable professional perspectives on what constitutes "healthy eating," (2) eating patterns of a child in the setting of variable caregiver eating practices, and (3) challenges to the promotion of a healthy caregiver-child dyadic diet within a social context. The results offer insight for future interventions that promote positive intergenerational transmission of health.

OBJECTIVE:Assess postintervention and dose effects of a child obesity prevention program, delivered from pregnancy through the age of 3 years, on child weight outcomes at the ages of 4 and 5 years among low-income Hispanic families. METHODS:As postintervention follow-up of the Starting Early Program (StEP) randomized controlled trial, StEP enrolled pregnant people in the third trimester to standard care control or the StEP intervention, which provided 15 nutrition and parenting support sessions. We analyzed differences in weight-for-age z scores (WFAz) and obesity status by group within intervention group analyses of program dose and moderation by adverse social drivers of health (SDoH). RESULTS:Weight data were available for 312 and 264 children aged 4 and 5 years, respectively. Mean WFAz (0.59 [1.08] vs 0.52 [1.16], P = .55; 0.60 [1.07] vs 0.58 [1.22], P = .86) and proportion with obesity (15.2% vs 15.6%, P = .90; 16.2% vs 19.5%, P = .47) were not different by intervention status at the ages of 4 and 5 years. The mean (SD) number of sessions attended was 8.7 (4.2) with the highest tertile attending 11 sessions or more. Lower WFAz and obesity prevalence were found for families with top tertile attendance. In moderation analysis, impacts on weight in children aged 5 years were greater for families with low social support compared high social support. CONCLUSION/CONCLUSIONS:Participation in StEP was not associated with postintervention differences in child weight. Higher attendance was associated with lower obesity prevalence, while treatment effects were greater for families with low social support. This highlights the need to evaluate program dose on long-term outcomes, especially for those with adverse SDoH.

OBJECTIVE:To explore how Sesame Workshop resources are perceived by Latino families with economic hardship and to highlight approaches for early heart healthy routine promotion. METHODS:We performed a purposive sampling of Latina mothers (n = 40) with young children experiencing economic hardship. Using an interview guide informed by the Consolidated Framework for Implementation Research, we recorded Spanish and English semistructured interviews, which were translated and transcribed verbatim. Partnering with Sesame Workshop, we iteratively incorporated Sesame Resources into interviews to query for acceptability. Using reflexive thematic analysis, we coded transcripts through textual analysis until saturation, prioritizing in vivo coding to capture participant voices. RESULTS:We constructed 3 themes. Parents connected with resources that 1) Reflect lived and multicultural experiences containing recognizable family scenes that can serve as tools to transfer a parent's own early routines or cultural rituals to their child. They appreciated resources that 2) Engage caregivers and children together, featuring elements for both children and adult caregivers with activities to highlight important caregivers and encourage shared play. Participants also reflected on how 3) Routines amplify family strengths and foster resilient reactions with feelings of decreased stress when daily practices become routines, promoting resilient reactions and supporting long-term goals when facing setbacks. CONCLUSIONS:An interdisciplinary partnership leveraged strengths of pediatric practitioners and Sesame Workshop to align future initiatives with the values and priorities of mothers of young children at risk for early obesity. Resultant themes inform strategies to promote heart healthy routines and relational health in young children with economic hardship.

OBJECTIVE:To highlight the need for more research about climate change's effects on child and adolescent mental health. METHOD/METHODS:Articles and reports were searched for in 12 pediatric journals and 10 international societies using the mesh terms "climate change and mental health," "climate change and children's mental health," and "eco-anxiety." Articles were scanned for relevancy using the terms "climate change," "climate crisis," "mental health," "child," "anxiety," and "mental anxiety." Relevant literature was compiled and analyzed. RESULTS:Although the climate crisis has been highlighted as a critical threat to the physical health of adolescents worldwide, its mental health impacts are far less recognized. Existing research on climate change and mental health is limited, primarily focusing on the acute response of adults directly affected by extreme weather events rather than climate change's emerging indirect mental health effects. Far more limited is the literature focusing on the mental health effects of climate change on adolescents and children, who are hypothesized to bear the brunt of the mental health detriment of climate change. In addition, nonstandardized scales and definitions and lack of nationally representative data, among many other things, hinder current understanding, attention, and evidence-based action to prevent and treat these effects. CONCLUSION/CONCLUSIONS:Gathering information regarding the climate crisis and children's mental health is paramount. Consequently, the development of a research workforce, a funding stream, and standardized methodology is necessary to properly investigate and aid adolescents and children facing the climate crisis's mental health effects.

BACKGROUND:Incidence estimates of post-acute sequelae of SARS-CoV-2 infection, also known as long-COVID, have varied across studies and changed over time. We estimated long-COVID incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). METHODS:This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and two control groups-- contemporary COVID-19 negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long-COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative (N3C), National Patient-Centered Clinical Research Network (PCORnet), and PEDSnet) implemented its own long-COVID definition. We introduced a harmonized definition for adults in a supplementary analysis. RESULTS:Overall, 4% of children and 10-26% of adults developed long-COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5-6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. CONCLUSION/CONCLUSIONS:Our findings indicate that preventing and mitigating long-COVID remains a public health priority. Examining temporal patterns and risk factors of long-COVID incidence informs our understanding of etiology and can improve prevention and management.