Christine B. San Giovanni

Background: The current literature suggests that screening for symptoms of pediatric obstructive sleep-disordered breathing (SDB) is low despite guidelines from the American Academy of Pediatrics to screen all children at well visits. Specific factors that affect screening rates for snoring have not been well delineated. Materials and Methods: This study is a retrospective chart review of children ages 2–12 who presented for well-child visits at an academic hospital network. Multivariable logistic regression was used to identify factors associated with documentation for SDB screening. Results: Of 1001 charts reviewed, 809 children met inclusion criteria (median age 5 IQR [3–8] years, 50.3% female). Less than half (45.4%) of the children were screened for snoring, and 16.1% of those screened had symptoms of SDB. Adjusted multivariable regression showed that screening was significantly higher in older children (OR: 2.19 [1.46–3.29]; p < 0.001 for 5- to less than 8-year-old children; OR: 2.37 [1.57–3.57]; p < 0.001 for 8- to less than 12-year-old children). Children of the Other race group were also found to have significantly lower screening rates than Black and White children (OR 0.44 [0.23–0.84]; p = 0.014). The odds of being screened were 94% lower in visits in which a medical trainee was involved (p < 0.001). The odds of being screened at a well-child visit were 3.7 times higher in encounters in which a templated note was used (p < 0.001). Conclusions: Less than half of the children presenting for well visits were screened for snoring in this cohort. Differences in screening were attenuated by trainee involvement and the use of templated notes, which presents further avenues to explore meeting guideline recommendations for SDB screening.

Children with asthma and obesity are more likely to have lower vitamin D levels, but the optimal replacement dose is unknown in this population. The objective of this study is identifying a vitamin D dose in children with obesity‐related asthma that safely achieves serum vitamin D levels of ≥ 40 ng/mL. This prospective multisite randomized controlled trial recruited children/adolescents with asthma and body mass index ≥ 85% for age/sex. Part 1 (dose finding), evaluated 4 oral vitamin D regimens for 16 weeks to identify a replacement dose that achieved serum vitamin D levels ≥ 40 ng/mL. Part 2 compared the replacement dose calculated from part 1 (50,000 IU loading dose with 8,000 IU daily) to standard of care (SOC) for 16 weeks to identify the proportion of children achieving target serum 25(OH)D level. Part 1 included 48 randomized participants. Part 2 included 64 participants. In Part 1, no SOC participants achieved target serum level, but 50–72.7% of participants in cohorts A‐C achieved the target serum level. In part 2, 78.6% of replacement dose participants achieved target serum level compared with none in the SOC arm. No related serious adverse events were reported. This trial confirmed a 50,000 IU loading dose plus 8,000 IU daily oral vitamin D as safe and effective in increasing serum 25(OH)D levels in children/adolescents with overweight/obesity to levels ≥ 40 ng/mL. Given the critical role of vitamin D in many conditions complicating childhood obesity, these data close a critical gap in our understanding of vitamin D dosing in children.

Objectives: Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents’ preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents’ preferred weight management app features and elicit facilitators and barriers...

Context: Pediatric obesity is now recognized as a chronic disease; yet few treatment options exist besides lifestyle modification therapy and bariatric surgery. We describe the limited availability of United States Food and Drug Administration (FDA)–approved antiobesity medications for adolescents and compare this to what is available for adults. We offer a rationale for off-label prescribing to assist with lifestyle modification therapy. We also highlight the need for more pharmacotherapy options and additional research into novel treatments for pediatric obesity. Case Description: We describe a patient who is struggling with managing her weight and starting to develop complications of obesity. We offer a framework in which off-label prescribing may be beneficial to patients who have been engaging in lifestyle modification therapy yet fail to see improvement. Conclusion: Lifestyle modification therapy is necessary but often insufficient in stimulating clinically meaningful weight loss when used alone in children and adolescents who struggle with weight management. Until more FDA-approved antiobesity medications are available, pediatricians may be able to help more patients achieve weight reduction goals by familiarizing themselves with the responsible use of off-label medications and implementing these tools to improve clinical outcomes. There is a critical need for more pharmacotherapy options to help pediatric patients in managing their weight and preventing or improving the insidious complications resulting from untreated obesity.

Youth with multi-morbidity (one or more chronic diseases) are at increased risk of further morbidity and early mortality as they enter their adult years. Recent increases in both asthma and obesity among youth have led to high health care utilization, increased health related complications, and expanded risks of subsequent cardiovascular disease burden. Common symptoms seen with asthma and obesity include fatigue, pain, depression, and anxiety. These symptoms can result in decreased physical activity, social isolation, and poor quality of life, which also may contribute to increased morbidity and mortality over time. Youth ages 10–17 are in a transitionary period where their overall health and disease management shifts from one of parental oversight to one where the youth gradually experience increased autonomy over their health and care management. Managing Asthma and Obesity Related Symptoms (MATADORS), is a mHealth technology-enhanced nurse-guided intervention that incorporates a novel mobile health application and motivational enhancement principles within a behavioral activation framework. Providing high-risk youth with strategies to enhance symptom self-management may result in decreased symptom prevalence, improved quality of life, and long-term reduction of cardiovascular morbidity and mortality as they move into adulthood. Moreover, developing low-cost, scalable tools with end-user input may facilitate promote early intervention and improved access to care, and reduce overall disease burden and healthcare costs.

Objective. This study tested the sensitivity of obesity diagnosis in electronic health records (EHRs) using body mass index (BMI) classification and identified variables associated with obesity diagnosis. Methods. Eligible children aged 2 to 18 years had a calculable BMI in 2017 and had at least 1 visit in 2016 and 2017. Sensitivity of clinical obesity diagnosis compared with children’s BMI percentile was calculated. Logistic regression was performed to determine variables associated with obesity diagnosis. Results. Analyses included 31 059 children with BMI at or above 95th percentile. Sensitivity of clinical obesity diagnosis was 35.81%. Clinical obesity diagnosis was more likely if the child had a well visit, had Medicaid insurance, was female, Hispanic or Black, had a chronic disease diagnosis, and saw a provider in a practice in an urban area or with academic affiliation. Conclusion. Sensitivity of clinical obesity diagnosis in EHR is low. Clinical obesity diagnosis is associated with nonmodifiable child-specific factors but also modifiable practice-specific factors.

Primary care providers (PCPs) have few resources to manage their overweight/obese patients. The purpose of study was to determine if technological resources, such as smartphone apps, may be useful for weight management counseling. PCPs were surveyed about their current use of resources for obesity management and whether smartphone apps would be helpful. Seventy-four PCPs completed the survey. Only 15% currently referred patients to smartphone apps at least sometimes or more often. When asked about features of apps, 66% were not aware of apps with interactive healthy eating games, yet if aware, 45% reported they would refer patients. Providers reported a greater likelihood of being more effective using an app compared with their current ability to manage overweight/obesity, 3.19 versus 2.85, P < .01. The majority of pediatric providers surveyed do not provide technological resources for their overweight/obese patients; yet, they appear interested in using smartphone apps as a resource.

This study tested whether parental knowledge of the American Academy of Pediatrics’ (AAP) recommendations on juice limits for children is associated with decreased consumption of juice and sugar-sweetened beverages (SSBs) among parents and children. Fifty-two parents with children 2 to 12 years old in a resident continuity clinic in East Harlem, New York, completed a survey asking about children’s and parent’s practice and quantitative consumption of juice and SSBs as well as parental knowledge of the AAP recommendations on juice limits. Parent’s total daily consumption of juice and SSBs (P < .01), parent’s score on the test of AAP guidelines (P = .04), and parent’s post–high school education (P = .01) were associated with children’s juice and SSB consumption in a multivariable linear regression model. Children’s consumption of juice and SSBs is positively associated with parental consumption of juice and SSBs and negatively associated with parental formal education and knowledge of the AAP recommendations on juice limits.