Patricia A. Richardson

Objective: Intervention in the earliest period of parenthood can make a strong, positive impact on parenting, yet engaging parents of newborns in parenting interventions can be difficult. Technological adaptation of important interventions can improve early engagement. This study reports the initial feasibility of the Creating Connections intervention, a technology-based intervention developed to support mothers of newborns, and feasibility of evaluating the intervention through a randomized clinical trial in pediatric primary care. The intervention includes: (a) a brief tablet-based intervention delivered during a newborn well-child pediatric check-up, and (b) tailored text messages delivered thereafter to boost intervention content. Intervention content includes empirically-supported aspects of parenting behaviors known to positively influence children’s social-emotional development. Method: Project recruitment took place in an ambulatory care pediatric clinic in a large Midwestern city. Mothers received information about infant soothing, book sharing, or both. Results: One-hundred and three parents learned about the program and 72 participated. Mothers were primarily Black/African American with incomes at or below $30,000. Only 50% of mothers that received text messages through the program completed follow-up, but these mothers gave overall positive ratings of text messages. Conclusions: Program engagement and ratings of parents support feasibility, but retention rates need improvement. Based on barriers and successes of this investigation, lessons learned about feasibility and acceptability are discussed. Implications for Impact Statement: This brief report describes a unique approach to using technology as part of a pediatric visit to deliver information to mothers of newborns aimed at promoting bonding.

Introduction: Despite well-documented pain disparities among adults from non-White and Hispanic groups, less is known about pain disparities in non-White and Hispanic pediatric populations. Objectives: We compare pain and related psychosocial factors at the individual (pain intensity, pain interference, pain catastrophizing, co-occurring symptoms), social (peer relations), and systemic (health insurance) levels among Hispanic and Non-Hispanic White (NHW) youth with chronic pain. Methods: Eight hundred thirty-seven (71.4% female) Hispanic (n = 268, 32%) and NHW (n = 569, 68%) youth ages 8 to 17 years (M = 14.00; SD = 2.54) completed a survey at their initial visit to a pain clinic. Independent sample t tests investigated mean differences in psychosocial factors at the individual and social levels. Chi-squared tests investigated differences at the systemic level. Bivariate correlations for each group were compared using Fisher r-to-z transformations. Results:.: Hispanic youth reported higher levels of pain intensity (t[811] = −2.75, P = 0.006). Groups did not differ in reports of other individual or social factors. Non-Hispanic White youth were more likely to have private insurance (OR, 5.66). All examined variables were significantly correlated among NHW youth. Correlations were weaker or nonsignificant among Hispanic youth. Fisher r-to-z transformations revealed these group differences to be significant. Conclusion: Hispanic youth report higher pain levels than NHW counterparts and lower likelihood of having private insurance. Pain and psychosocial factors correlate differently among the 2 groups highlighting a need to better understand the chronic pain experiences of diverse youth because models derived primarily from NHW populations may not generalize across ethnic and racial groups.

Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8–17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science.

Purpose of Review For many children, the SARS-CoV-2 pandemic has impacted the experience and treatment of their pain. This narrative review draws from the pain literature and emerging findings from COVID-19 research to highlight potentially meaningful directions for clinical consideration and empirical inquiry in the months and years to come. Recent Findings COVID-19 has been linked to diffuse acute pains as well as chronic pain sequelae. Contextual factors known to increase vulnerability for pain and associated functional disability have been exacerbated during the pandemic. Beyond these salient concerns has been the remarkable resilience demonstrated by patients and providers as healthcare systems have sought to harness creativity and innovative digital solutions to support optimal child wellbeing throughout this crisis. Summary Ongoing research is needed to elucidate the short- and long-term effects of the pandemic on children’s pain and to consider how the delivery of treatment via digital technology has impacted existing paradigms of pain management.

Knowing the host range of a pathogen is critical to developing and implementing effective disease management programs. Calonectria pseudonaviculata (Cps) is known to attack a number of species, varieties, and cultivars in the genus Buxus as well as three Pachysandra species (Pachysandra terminalis, Pachysandra procumbens, and Pachysandra axillaris) and several Sarcococca species, all in the Buxaceae family. The objective of this study was to evaluate non-Buxaceae groundcovers and companion plants commonly associated with boxwood plantings for their susceptibility to Cps. Twenty-seven plant species belonging to 21 families were exposed to different levels of inoculum: 50 to 300 conidia per drop for detached leaf assays and 30,000 to 120,000 conidia per 1 ml for whole-plant assays. Inoculated plants were incubated in humid environments for at least 48 h to facilitate infection. Cps infection and sporulation were observed on 12 plant species: Alchemilla mollis, Arctostaphylos uva-ursi, Brunnera macrophylla, Epimedium × youngianum, Galium odoratum, Geranium sanguineum, Phlox subulata, Tiarella cordifolia, Callirhoe involucrata, Iberis sempervirens, Mazus reptans, and Vinca minor. These results suggest that there may be more hosts of Cps commonly grown in nurseries and landscapes. If corroborated by observations of natural infection, these findings have implications for the Boxwood Blight Cleanliness Program instituted by the National Plant Board and for planning disease mitigation at production and in the landscape.

Objectives: Valid and efficient assessment of patient-reported outcomes remains a priority to guide pain treatment and research. PROMIS pediatric self-report and parent proxy measures offer feasible and rigorous evaluation of functioning in children with chronic conditions, including pain. A key challenge is determining the usefulness of multisource information from children and caregivers for understanding pain and function. Our primary aim examined child-caregiver agreement across child functioning domains. Our secondary aim examined child and caregiver factors associated with the child-caregiver agreement. Materials and Methods: A sample of 806 children with chronic pain (M _age=14.50 y; 72% female individuals) and a caregiver (M _age=45.82 y; 85% mothers) completed PROMIS pediatric self-report and parent proxy measures of anxiety, depression, fatigue, pain interference, and mobility before intake in an interdisciplinary outpatient pediatric chronic pain program. Results: The agreement was poor to good depending on the evaluation method (effect size, intraclass correlation, and clinical significance interpretation). Caregivers generally reported worse child symptoms across domains compared with child self-report. The greatest discrepancy was observed for child anxiety, pain interference, and peer relations, with the greatest agreement for child mobility. The greater caregiver-child discrepancy was found for younger children, girls, with a higher child or caregiver pain catastrophizing, and poorer caregiver physical or mental health. Discussion: Findings are discussed within the interpersonal context of pain and indicate the relevance of both child and caregiver perspectives to personalize chronic pain assessment and treatment. Findings can be used by clinicians and researchers to guide whether and how to integrate multi-informant reports about child chronic pain functioning.

Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.

Caregivers play an integral role in promoting children's emotion regulation, while children's individual physiology affects how they respond to the caregiving environment. Relatively little is known about how fathering influences toddler emotion regulation, particularly within African American and low‐income communities, where risk related to the development of emotion regulation is higher. This study investigated relations among fathering, toddler parasympathetic regulation, and toddler emotion regulation in a sample of 92 families. Fathering was assessed during two interactions: engagement following a stressor during a triadic task and a dyadic play task. Respiratory sinus arrhythmia (resting and reactivity) was obtained as an index of toddler parasympathetic arousal. Findings demonstrated an association between fathers’ engagement poststressor and toddler emotion regulation. Toddler RSA moderated this association: toddlers with elevated levels of resting RSA benefitted from parenting engagement following a stressor. Fathering during play did not relate to toddler emotion regulation. The importance of fathering and physiologic contexts in early regulatory development is discussed.