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With an increase in the diagnosis of autism spectrum disorder in the United States, many of whom have higher intellectual ability, there is a predicted increase in the number of college-bound students. Affected young adults face a “Services Cliff” as they transition into adulthood. Our study examined a nationally represented sample of freshman students and found that academic achievements in autistic students are comparable to their peers when they first enter college. The students however have more mental health and physical health problems compared to their non-autistic peers. Poor health maybe a major contributing factor to the lower graduation rates among autistic students. College-bound autistic students may continue to require services through college for them to be successful and graduate.

This book addresses the unique healthcare needs of adults with chronic childhood illnesses. It presents a model of primary and secondary prevention for emerging adulthood-primary prevention in which all young adults are screened for high-risk behaviors and health needs and secondary prevention in which young adults with chronic childhood conditions are optimized through coordinated care, connections to community resources and social/family support.This book is organized in five parts. Part I provides a detailed overview of the health care transition from pediatrics to adult medicine from both a policy and practice perspective. In Part II, the concept of emerging adulthood as a developmental period is explored and strategies for providing improved comprehensive care for this age group are discussed. Part III reviews specific chronic childhood conditions, such as attention-deficit/hyperactivity disorder, autism, cystic fibrosis, and diabetes mellitus, and offers clinical cases and summary reports that can be used as a quick guides to each condition. In Part IV, additional clinical considerations that are not necessarily condition-specific but are highly relevant to the care of young adults with chronic childhood conditions are examined. Part V describes the socio-legal issues involved in caring for this population. Care of Adults with Chronic Childhood Conditions provides primary care providers with a new framework for the care of young adults and identifies opportunities to influence patient health outcomes over a life trajectory.

Early reports from around the world described COVID-19 as an illness characterized primarily by fever and cough.1,2 Due to limited testing capacity, testing access was often initially limited to individuals who presented with these symptoms. Because of the potential for HCWs to spread SARS-CoV-2 to patients and coworkers, our health system opted for a low threshold for testing to better characterize the spectrum of disease and reduce inadvertent spread. [...]one-third of HCWs in our study did not report fever or cough as one of their symptoms, and these individuals would have been missed by more restrictive testing guidelines. Employee health programs should message that early COVID-19 can present with subtle viral symptoms, including those mimicking mild upper-respiratory infections or allergies, and that individuals should have a low threshold to present for evaluation and testing.

Objective The aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children’s BMI trajectories. Methods The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72 months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods. Results Approximately one-third of 4-year-old females and males were overweight and/or obese. African-American and Latino children displayed higher predicted mean BMI scores and differing mean BMI trajectories, compared with White children, adjusting for time-independent and time-dependent predictors. Several factors were significantly associated with lower mean BMI trajectories, including very low birth weight, higher maternal education level, residing in a two-parent household, and breastfeeding during infancy. Greater consumption of soda and fast food was associated with higher mean BMI growth. Soda consumption was a particularly strong predictor of mean BMI growth trajectory for young Black children. Neither the child’s inactivity linked to television viewing nor fruit nor vegetable consumption was predictive of BMI growth for any racial/ethnic group. Conclusion Significant racial and ethnic differences are discernible in BMI trajectories among young children. Raising parents’ and health practitioners’ awareness of how fast food and sweetened-beverage consumption contributes to early obesity and growth in BMI—especially for Blacks and Latinos—could improve the health status of young children.

To examine parent concerns about development, learning, and behavior for young children of Mexican origin, and to identify whether these reports differ by families' citizenship/documentation status. Data come from the 2005 California Health Interview Survey, a population-based random-digit dial telephone survey of California's noninstitutionalized population. California Health Inerview Survey (CHIS) investigators completed interviews of 43 020 households with a total of 5856 children under age 6 years, of whom 1786 were reported being of Mexican origin. Developmental risk was measured by parent concerns elicited by the Parents' Evaluation of Developmental Status. We used bivariate and multivariate analyses to examine associations between developmental risk and family citizenship/documentation status (parents are undocumented, at least one documented noncitizen parent, or both parents are US citizens) among children of Mexican origin and US-born non-Latino white children, after adjusting for age, income, parental education, and predominant household language. In multivariate analyses, children of Mexican origin did not differ significantly from US-born white children in developmental risk (odds ratio 1.12, 95% confidence interval 0.88–1.42). In subgroup analyses, children of Mexican origin with undocumented parents had higher odds of developmental risk (odds ratio 1.53, 95% confidence interval 1.00–2.33) than non-Latino white children whose parents were citizens, after adjusting for confounders. Mexican children with undocumented parents have greater parent-reported developmental risk than Mexican and white children whose parents are US citizens or otherwise legally documented. More research is needed to understand the roles of immigration stress and home environments on the developmental risks of children in households with undocumented parents.

The proportion of children suffering from chronic illnesses—such as asthma and obesity, which have significant environmental components—is increasing. Chronic disease states previously seen only in adulthood are emerging during childhood, and health inequalities by social class are increasing. Advocacy to ensure environmental health and to protect from the biological embedding of toxic stress has become a fundamental part of pediatrics. We have presented the rationale for addressing environmental and social determinants of children’s health, the epidemiology of issues facing children’s health, recent innovations in pediatric medical education that have incorporated public health principles, and policy opportunities that have arisen with the passage of the 2010 Patient Protection and Affordable Care Act.

The aim of this study was to examine parental reports of receiving a child developmental assessment (DA), and the child, family, and type of health care setting characteristics and well-child care processes associated with receiving this aspect of preventive developmental care. The 2007 National Survey of Children’s Health was used to study 16 223 children, aged 10 months to 4 years, who received a DA with a structured questionnaire from their primary care provider in the previous 12 months. Data were adjusted for child characteristics, family socioeconomic factors, type of health care setting, and processes of care. Few children were assessed for developmental delays by using developmental questionnaires (28%). A greater percentage of parents of children with public insurance reported receiving a developmental questionnaire compared with parents of children who were uninsured or privately insured (32% vs 26% and 25%, respectively; P = .02). The adjusted odds of receiving a developmental questionnaire were higher for children with public insurance than private insurance (odds ratio [OR] 1.35, 95% confidence interval [CI], 1.05–1.73), higher for children whose usual place of care was a clinic or health center than a doctor’s office (OR 1.36, 95% CI, 1.07–1.74), and higher for children reporting adequate family-centered care (OR 1.41, 95% CI, 1.14–1.74). Parental receipt of developmental questionnaires is low and varies by type of insurance, type of place for usual source of care, and adequacy of family-centered care. There is room for improvement in the provision of developmental questionnaires and, our results suggest, areas for continuing research to understand variations in DA practices.

Nearly 20% of children in the United States have special health care needs, and they often experience disparities in health outcomes. This article reviews barriers to and facilitators of primary pediatric care for children within four defined categories of disability: (1) physical disabilities, both temporary and permanent; (2) chronic conditions requiring accommodations, including mental health conditions; (3) sensory disabilities and conditions; and (4) cognitive, educational, neurodevelopmental, and social disabilities. Primary care facilitators include interventions for both providers and patients that focus on time as a valued resource, provide psychosocial support, coordinate interdisciplinary teams of care, and provide training for providers. Barriers include exclusion of patients with disabilities from research trials and gaps in educational reform regarding ableism and hidden disabilities. Identified facilitators should be implemented on a larger scale, and barriers need to be addressed further so we may better support children with disabilities. [Pediatr Ann. 2022;51(6):e243–e253.]

A substantial proportion of college students experience challenges transitioning from pediatrics to the adult healthcare system. Combined internal medicine and pediatrics (Med-Peds) providers are frequently tasked with facilitating this transition and promoting the health and well-being of this population. There is an increasing proportion of college students with Attention Deficit Hyperactivity Disorder (ADHD) in the U.S. This population experiences particularly pronounced challenges navigating the healthcare system and, as a result, often contends with fragmented healthcare. These issues are due to a range of factors, including lack of physician training, education, and resources, as well as a dearth of available research that can inform Med-Peds providers' efforts to support college students with ADHD. The current study compared a nationally representative sample of U.S. college freshmen with ADHD to those without ADHD on health, academic, and non-academic capacities. This study analyzed population-weighted data from the Cooperative Institutional Research Program's Freshman Survey. Students with ADHD were more likely to report co-occurring conditions and feelings of depression and overwhelm. They were less likely to report emotional health that was above average or in the highest 10 percentile. Although they reported lower overall academic aspirations, they were more likely to rate themselves in the highest 10th percentile on a range of non-academic capacities. The results from this study can inform efforts among Med-Peds providers seeking to promote the health and well-being of college students with ADHD.