Examining provider anticipatory guidance for adolescents' preventive health: A latent class approach

BACKGROUND

Low rates of anticipatory guidance (AG) are reported across studies with adolescents, and little is known about how these conversations differ across early versus middle adolescence. This study explored adolescent-provider AG conversations for preventive health skills; the study objectives were to (1) identify patterns of provider-adolescent AG conversations across early and middle adolescence and (2) determine socio-demographic characteristics associated with these AG conversations.

DESIGN AND METHOD

Data from the 2019 National Survey of Children's Health were used to identify patterns of provider-adolescent AG conversations. The sample included 5500 early and 6730 middle adolescents (Mage = 14.67 years old, SD = 1.71, 51.7% boys, 79% White). Multiple group latent class analysis and multinomial regressions were estimated using four indicators of AG conversations (i.e., skills to manage health and healthcare, changes in healthcare that happen at 18, making positive choices about health, and receiving a medical history summary).

RESULTS

Three types of AG conversations were identified: high AG, low AG, and parent unaware. Among early and middle adolescents, adolescents that were older, girls, had private health insurance, and a personal provider were less likely to receive high AG compared to other types of AG.

CONCLUSIONS

Policies and strategies to engage adolescents in AG conversations during and outside of the medical appointment are needed.

PRACTICE IMPLICATIONS

Tools, such as brief screeners, can be used to ensure all adolescents are receiving high AG. School-based health centers, community centers and organizations, and telehealth appointments with medical professionals may be additional opportunities for adolescents to receive AG.

Conversation starters: Understanding the facilitators and barriers to physician-initiated secure firearm storage conversations

OBJECTIVE

This paper aims to understand what general practice physicians (GPs) perceive as facilitators and barriers to initiating anticipatory guidance around firearm safety.

METHODS

We employ qualitative interviewing to have in-depth conversations with 18 GPs. Participants were randomly selected from a national panel of physicians and screened for specialty (general practice or internist), practice setting (not hospital-based), and time spent on direct patient care (80% +). The sample was stratified at the state level by the presence of safe storage or child access protection laws, with half of the participants selected from each stratum.

RESULTS

We identify five physician-perceived barriers to providing secure firearm storage counseling, including inadequate screening mechanisms to trigger conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for training.

CONCLUSION

Prior to focusing on how to have conversations about firearm safety, interventions designed to increase the incidence of physician-initiated guidance need to address the structural issues of why those conversations typically do not occur.

PRACTICE IMPLICATIONS

Findings indicate the need for revised screening tools and improved physician education as to who is at risk for gun injury and how to best approach firearm safety conversations.

Execution of anticipatory guidance and the knowledge and practice gap among caregivers in Southern Taiwan: A retrospective study

BACKGROUND/PURPOSE

This study examined the practice rate of Anticipatory Guidance (AG) and the gap between knowledge and practice among caregivers.

METHODS

We retrospectively collected data from caregivers who brought their children for seven age-based well-child visits (birth to 7 years old) and seven corresponding AG checklists for practice (each ranged from 16 to 19 guidance items, 118 items in total) between 2015 and 2017. Practice rates of guidance items and their association with children's sex, age, residence, and body mass index were collected and analyzed.

RESULTS

We enrolled 2310 caregivers (330 per well-child visit). Average practice rates of guidance items in the seven AG checklists were 77.6%-95.1%, generally without significant differences between urban/rural or male/female children. However, lower (<80%) rates were observed for 32 items, including dental check-ups (38.9%), use of fluoride toothpaste (44.6%), screen time (69.4%), and drinking less sugar-sweetened beverages (SSBs) (75.5%), with corresponding knowledge-to-practice gap rates of 55.5%, 47.9%, 30.3%, and 23.8%, respectively. "Drinking less SSBs" was the only item with a higher obesity rate in the non-achieved group versus the achieved group (16.7% vs. 7.4%, p = 0.036; odds ratio: 3.509, 95% CI: 1.153-10.677, p = 0.027).

CONCLUSION

Caregivers in Taiwan practiced most AG recommendations. However, dental check-ups, fluoride toothpaste use, drinking less SSBs, and limiting screen time were less executed items. A higher obesity rate was found among 3-7-year-old children whose caregivers failed to practice the "Drink less SSBs" guidance. Strategies to overcome the gap between knowledge and practice are needed to improve these less-achieved guidance items.

A qualitative assessment of adolescent perspectives on patient education in the outpatient setting

Objective

To explore adolescent perspectives on the content and delivery of anticipatory guidance (AG), both during and after outpatient visits, in order to develop targeted resources and educational material for adolescent patients.

Methods

Semi-structured phone interviews among patients ages 12 to 21 seen between May-July 2021 at four outpatient sites of NewYork Presbyterian Hospital were recorded, transcribed and analyzed using thematic analysis. Content domains included attitudes toward and preferences around AG, discharge instructions and patient education resources.

Results

Twenty-eight of 156 recruited patients completed interviews; 52% received an After Visit Summary (AVS); of the 48% who did not receive it, half of them expressed interest in receiving one. Themes included positive perceptions of the AVS, patient-physician communication, multimodal delivery of educational materials, and critical discussion topics such as mental health and nutrition.

Conclusion

Adolescents value the AVS and prefer multimodal materials and topics that are specifically geared towards them, rather than their caregivers.

Innovation

This study is the first to explore adolescent perspectives on AG and after-visit informational materials. These findings may help more effectively reach, educate and engage adolescent patients in the primary care setting by guiding the focused development of patient-centered instructions and resources.

Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance

OBJECTIVE

Over the last decade, there has been an increased focus on firearm use in violent acts and suicides. There is no known published firearm safety curriculum specific to psychiatric training and limited guidance on curriculum development from national organizations. The authors' goals were to develop a firearm lecture series that would encompass essential knowledge related to firearm safety and risk assessments and assess its effect on psychiatric residents' interest and confidence in firearm safety guidance.

METHODS

The authors developed a six-lecture series on firearm safety that was conducted over all post-graduate year (PGY) training levels and a grand rounds on basic firearm safety. All levels of psychiatry residents at one urban academic center participated in a pre- and post-lecture series questionnaire designed to evaluate attitudes related to firearm safety guidance. They developed and administered the questionnaire through New Innovations collecting qualitative and quantitative data for analysis. The quantitative analysis was completed using paired t-test.

RESULTS

Forty-seven residents participated. Twenty-seven respondents met inclusion criteria: attended at least one lecture or the grand rounds, completed pre- and post-lecture surveys, and submitted their pre-lecture survey before their first lecture. After the educational intervention, there was a statistically significant increase (p<0.05) in interest in firearm safety, and confidence in all areas surveyed-risk assessment, safety guidance, and pertinent legislation.

CONCLUSIONS

The curriculum increased residents' interest and confidence in providing firearm safety guidance. Areas of development include assessing the curriculum's impact on clinical practice.

Home-visiting programs based on the Brazelton approach: a scoping review

This review maps and summarizes the quantitative studies on the main outcomes associated with home visiting (HV) programs using Brazelton methods aimed at supporting expectant and new parents. One hundred thirty-seven records were identified, and 19 records were selected. The design of our study was based on the methodological framework for conducting scoping reviews. Quality was assessed through the Jadad scale. Studies were coded for participant characteristics (number, mean age, and risk status), methodology (recruitment, home visit frequency, age of the child, Brazelton method, and research design), and intervention outcomes (on infants, parents, and home visitors). The studies mostly focused on the impact of Brazelton HV programs on infant development, the mother's psychological well-being, mother-infant interaction, and home visitor satisfaction. Experimental and quasi-experimental studies consistently have shown that parents receiving the intervention have greater knowledge of their children. Results are less conclusive regarding the intervention's impact on other domains of child development, mothers' psychological well-being, and mothers' sensitivity to the relationship with the child. Overall, the results suggest that the improvements associated with the intervention are mainly influenced by the risk status of families. Further research is needed to better understand the benefits of HV based on the Brazelton approach and the target population that may benefit most from this intervention.

CONCLUSION

 Although the impact of the Brazelton home visiting intervention is not yet fully understood, there is promising evidence of its positive effects on child development, maternal well-being, and parental knowledge. Further research with consistent methodologies and larger sample sizes is needed to strengthen our understanding. However, existing findings in the literature underscore the importance of preventive interventions such as the Brazelton program in improving family well-being, with potential long-term benefits.

WHAT IS KNOWN

• Home visiting programs based on the Brazelton approach aim to increase parents' knowledge and sensitivity to their children. • There is no clear picture in the literature of the effectiveness of these programs.

WHAT IS NEW

• Existing studies consistently show the effectiveness of these programs to improve parents' knowledge of their children. • Findings on the impact of these programs on child development, mothers' psychological well-being and sensitivity to their child are inconclusive and may be influenced by the risk status.

Psychosis following caffeine consumption in a young adolescent: Review of case and literature

Caffeine, a popular over-the-counter methylxanthine, is widely consumed for its potent psychoactive properties. Toxicity generally occurs with intentional overdose and is often multisystemic and life-threatening. Consumption by children is rarely planned, and safe doses are potentially toxic in them. A 12-year-old boy whose parents had denied him coffee on several occasions eventually had access to it. The caffeine dose ingested was sub-toxic although he developed severe and life-threatening multisystemic caffeinism. Following ingestion, he became aggressive and was talking irrationally, with visual and auditory hallucinations. In addition, he had severe abdominal pain, multiple vomiting episodes, circulatory collapse, hypertension, angioedema, dysfunctional tear syndrome, hyperglycemia, ketonuria, hypokalemia, and metabolic acidosis. The clinical presentation, laboratory findings, and interventions are reviewed and discussed. Besides routine immunization, routine anticipatory guidance should be at the center of preventive pediatrics. Packaging of caffeinated beverages should also target the prevention of caffeine toxicity in children.

Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention; the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this covid pandemic.

Materials and methods

A total of 222 mothers with 9-24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre- and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted.

Statistical analysis

The data was analyzed using Statistical Package for the Social Sciences 13.

Result

Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI).

Conclusion

In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC).

How to cite this article

Aravind A, Sathyaprasad S, Ilyas I. Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(2):227-236.

Delivering Anticipatory Guidance About Technology Use to Adolescents in Primary Care: Rates in a Representative California Sample

PURPOSE

This study aimed to investigate rates of anticipatory guidance about technology use in primary care, as recommended by the American Academy of Pediatrics Bright Futures Guidelines, in a representative sample of California adolescents.

METHODS

Adolescents 12-17 years of age were interviewed as part of the California Health Interview Survey, the largest state health surveillance survey in the U.S. Participants who reported seeing a doctor for a physical examination or checkup in the prior year were asked if their doctor had talked to them about technology use.

RESULTS

Overall, 29.7% of the 742 participants reported that their doctor talked to them about technology use. There were no statistically significant differences in rates by age, sex, race/ethnicity, household income, or family type.

CONCLUSIONS

While the American Academy of Pediatrics recommends that providers deliver anticipatory guidance about technology use to adolescents in primary care, less than one-third of adolescents surveyed reported having conversations about this topic with their doctor. Given concerns about potential impacts of technology use on adolescent health, medical education should facilitate provider screening and counseling of adolescents about technology use in primary care settings.

Attitudes and perceived barriers to firearm safety anticipatory guidance by pediatricians: a statewide perspective

BACKGROUND

Firearms are the second leading cause of injury-related death in American children. Safe storage of firearms is associated with a significantly decreased odds of firearm-related death, however more than half of US firearm owners store at least one firearm unlocked or accessible to a minor. While guidance by primary care providers has been shown to improve storage practices, firearm safety counseling occurs infrequently in the primary care setting. The primary objective of this study was to describe pediatricians' perceived barriers to providing firearm safety education to families in the pediatric primary care setting. Secondary objectives included identifying pediatric provider attitudes and current practices around firearm counseling.

METHODS

This was a cross-sectional survey of pediatric primary care providers in Ohio. Participants were recruited from the Ohio AAP email list over a 3-month period. Only pediatric primary care providers in Ohio were included; subspecialists, residents and non-practicing physicians were excluded. Participants completed an anonymous online survey detailing practice patterns around and barriers to providing firearm safety counseling. Three follow-up emails were sent to pediatricians that failed to initially respond. Response frequencies were calculated using Microsoft Excel.

RESULTS

Two hundred eighty-nine pediatricians completed the survey and 149 met inclusion criteria for analysis. One hundred seven (72%) respondents agreed that it is the responsibility of the pediatric primary care provider to discuss safe storage. Counseling, however, occurred infrequently with 119 (80%) of respondents performing firearm safety education at fewer than half of well child visits. The most commonly cited barriers to providing counseling were lack of time during office visits, lack of education and few resources to provide to families. A majority, 82 of pediatric providers (55%), agreed they would counsel more if given additional training, with 110 (74%) conveying they would distribute firearm safety devices to families if these were available in their practice.

CONCLUSION

Ohio pediatricians agree that it is the responsibility of the primary care provider to discuss firearm safety. However, counseling occurs infrequently in the primary care setting due to a lack of time, provider education and available resources. Improving access to resources for primary care pediatricians will be critical in helping educate families in order to protect their children through improved storage practices.

Preparing for Puberty in Girls With Special Needs: A Cohort Study of Caregiver Concerns and Patient Outcomes

STUDY OBJECTIVE

To characterize the patient population with cognitive or physical impairments that presents for anticipatory guidance of puberty, evaluate caregiver concerns with respect to puberty, and describe chosen management strategies and outcomes following menarche.

DESIGN

Retrospective cohort study SETTING: Academic tertiary care women and children's hospital PARTICIPANTS: Eligible female patients with special needs up to age 26 years presenting for anticipatory guidance from 2009 to 2018 MAIN OUTCOME MEASURES: Primary outcomes included characterization of patients presenting for anticipatory guidance and their reasons for menstrual management. Secondary outcomes were satisfaction with menstrual management and bleeding patterns.

RESULTS

A total of 61 patients presented for anticipatory guidance of puberty, on average 13.5 months prior to menarche. Compared to the overall adolescent population with special needs who presented for gynecologic care, patients who had autism spectrum disorder (ASD), were nonverbal, or had attention-deficit/hyperactivity disorder (ADD/ADHD) were more likely to present for a pre-menarchal visit to discuss anticipated pubertal development (P < .001, P = .009, and P = .04, respectively). More than half of families described potential behavioral changes as their main concern. The majority of post-menarchal patients (80%) desired hormonal management of menses, including 30% of patients who had placement of a levonorgestrel intrauterine device. In all, 96% of patients were satisfied with their final menstrual bleeding pattern; 50% achieved amenorrhea or light spotting.

CONCLUSIONS

This study describes the important role of pre-menarchal reproductive counseling for girls with disabilities. Anticipation of puberty causes great anxiety in families and patients, especially those with ASD, ADD/ADHD, and non-verbal status. Providers should consider initiating these conversations early in pubertal development.

The 2020 Rourke Baby Record release: A time for reflection and looking forward

The Rourke Baby Record (RBR) is a health supervision guide for providing care and anticipatory guidance to children aged 0 to 5 years in Canada. First developed in 1979, it has been revised regularly to ensure that it remains current and evidence-informed. The RBR has a longstanding relationship with the Canadian Paediatric Society (CPS), and relies on this organization for its expertise to inform the RBR guide's content. The 2020 edition of the RBR includes many recommendations based on evidence provided in current CPS position statements. The RBR Working Group is planning to develop app-based resources and an adapted RBR for clinical care provision in this challenging pandemic time to ensure that Canadian infants and children continue to receive high-quality care.

Les soins complets de l'enfant ayant la paralysie cérébrale et capable de marcher (GMFCS I et II) : une perspective canadienne

La paralysie cérébrale (PC), qui est l'incapacité physique la plus fréquente au Canada, touche de deux à trois personnes sur 1 000. Au cours de leur carrière, les pédiatres verront et soigneront à coup sûr des enfants ayant la PC et leur famille. Le pédiatre général joue un rôle crucial dans les soins de l'enfant ayant la PC, qu'il s'agisse de poser le diagnostic ou d'assurer l'accès à une maison médicale (medical home), de garantir la coordination des soins ou de donner des conseils et des soins préventifs pour assurer sa santé et son bien-être. La fiche de santé et de bien-être en cas de PC qui accompagne le présent point de pratique peut aider à la fois le praticien et la famille de l'enfant à explorer des aspects essentiels de la santé, du fonctionnement, de la participation aux activités et du bien-être. Cette fiche peut être utilisée conjointement avec d'autres guides de promotion de la santé fondés sur des données probantes, comme le Relevé postnatal Rourke et le Relevé médical Greig, pour renseigner les cliniciens qui s'occupent d'enfants ayant la PC et capables de marcher (niveaux I et II du système de classification de la fonction motrice globale) sur des troubles et des domaines de santé particuliers.

Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): A Canadian perspective

In Canada, cerebral palsy (CP) is the most common physical disability, affecting approximately 2 to 3 per 1,000 individuals. Paediatricians are sure to encounter and care for children with CP and their families. The role of the general paediatrician in caring for a child with CP is crucial, from diagnosis to providing a 'medical home', and from ensuring care coordination to delivering anticipatory guidance and preventive health and wellness care. The CP Health and Wellness Record that accompanies this practice point can assist both practitioners and children's families by exploring key areas of health, function, participation, and wellness. This record may be used alongside other evidence-based health promotion guides, such as the Rourke Baby Record and the Greig Health Record, to prompt clinicians caring for ambulatory children with CP (Gross Motor Function Classification System [GMFCS] levels I and II) on specific health issues and domains.

Evaluation of an intervention aimed at supporting new parents: the Baby Newsletter project

Background

Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy.

Methods

This was a non-randomized pre/post-intervention controlled study.

All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d’Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded.

Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12 months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE.

Variations of each TOPSE score between delivery and 12 months in the two groups were compared, adjusting for parity, education, age of parents, and child’s sex, and stratifying by parity and education.

Results /findings

One hundred thirty-six families accepted to participate in the study. Scores at 12 months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: − 3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child.

Conclusions

The intervention was effective in improving parents’ ability to play. However, it risks worsening existing differences between parents with high and with low education levels.

Trial registration

Clinical trial registration: NCT03268408.

Development and validation of a Chinese parental health literacy questionnaire for caregivers of children 0 to 3 years old

Background

Given the limited information on parental health literacy measurements, the study aimed to develop and validate the Chinese Parental Health Literacy Questionnaire for caregivers of children 0 to 3 years old.

Methods

We conducted a validity and reliability study of the questionnaire through a cross-sectional survey and test-retest analysis respectively between March and April 2017. We recruited 807 caregivers of children 0 to 3 years old, among them 101 caregivers completed the test-retest assessment with 2 weeks interval. The reliability was determined by internal consistency, spilt-half reliability and test-retest reliability. The construct validity was assessed by confirmatory factor analysis.

Results

The 39-question Chinese Parental Health Literacy Questionnaire was demonstrated high internal consistency (Cronbach’s α = 0.89), spilt-half reliability (Spearman-Brown coefficient = 0.92) and test-retest reliability (Pearson correlation coefficient = 0.82). The confirmatory factor analysis showed that the construct of the questionnaire fitted well with the hypothetical model. The participants’ test scores of the Chinese Parental Health Literacy Questionnaire in the cross-sectional survey were positively associated with caregivers being mothers, more educated, the children with Shanghai Hukou, having only one child in the family, and higher family income.

Conclusion

The Chinese Parental Health Literacy Questionnaire demonstrated good reliability and validity, which could potentially be used as an effective evaluation instrument to assess parental health literacy.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1670-9) contains supplementary material, which is available to authorized users.

Pilot of primary care physician discussion and resource allocation after screening for unintentional injuries and social determinants of health

Background

Standardized screening tools used by pediatric providers can help determine a child’s injury and social risks. This study determined if an office-based quality improvement program could increase targeted anticipatory guidance and community resource distribution to families.

Methods

Practices recruited from the Ohio Chapter, American Academy of Pediatrics’ database self-selected to participate in a quality improvement project. Two age-appropriate screening tools, corresponding talking points and local resources for birth–1 year and 1–5 year aged children were developed for unintentional injury and social health determinant topics. After a one-day learning session, practice teams implemented the tools into well-child care visits for children < 5 years of age. Two months of retrospective baseline data was collected for each participating clinician. During the 6-month collaborative, physicians randomly reviewed 5 screening tools monthly for each age category to identify injury and social risk discussions and to determine if resources were provided. Frequencies of counseling and resource distribution were calculated. Participating providers received Maintenance of Certification IV credit.

Results

Ten practices (18 providers) participated and 667 tools (n = 313, birth-1 year, n = 354, 1–5 year) were collected. For birth–1 year, the most common risky behaviors were related to unintentional injuries: no CPR training 164(52%), car seat not checked 149(48%) and home furniture not secured 117 (37%). For 1–5 year screens, unintentional injuries were also most common: no CPR training 222(63%), car seat not checked 203(57%) and access to choking hazards 198(56%). Families practiced riskier behaviors for unintentional injuries compared to social risks for both age groups (birth – 1 year, social 189/4801 (4%) vs. unintentional injury questions 999/6260 (16%) and 1–5 years, social 271/5451 (5%) vs unintentional injury questions 1140/6372 (18%). From baseline, discussions increased from 31% to 83% for birth – 1 year and 24% to 86% for 1–5 year families. Resource distribution increased by 63% for birth-1 year and 69% for 1–5 year families by pilot conclusion.

Conclusions

Using standardized screening tools in an office setting shows that families often practice unintentional injury risks more than having social concerns. After screening, appropriate resources can be provided to families to encourage behavior change.

Effect of Dental Health Education on the Knowledge and Attitude Among Expectant Mothers: A Questionnaire Study

Background:

Although dental caries levels have declined and stabilized the world over, the problem of early childhood caries has remained persistent in many areas of the world affecting certain segments of society, especially the socially deprived, who remain at high risk to this disease. Parents have an essential role in mediating between their children and environment for which prenatal period is the best time for health interventions. This mediation is done through preventive services they provide to their children such as dietary habits supervision, oral hygiene performance, and other practices that can be enhanced by prenatal dental health education.

Purpose:

The purpose of the study was to evaluate, by means of a questionnaire, the expectant mother’s knowledge and attitude toward dental health and to test the effectiveness of the health education tool.

Materials and Methods:

The baseline questionnaire consisted of 27 questions, which was distributed to 138 participants. Subsequently, provision for dental health education was made in batches of 20. After 3 weeks, 10 questions were randomly selected from the first questionnaire for reassessment session. Paired t test was used for statistical analysis.

Results:

The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%.

Conclusion:

Knowledge and attitude of mothers was found to increase on provision of dental health education, which were retained even after a period of 3 weeks.

Helping Mothers Reach Personal Breastfeeding Goals

Professional organizations worldwide recommend exclusive human milk/breastfeeding for the first 6 months of life, and continued breastfeeding with appropriate complementary foods for 1 year or more. This article focuses on the importance of prenatal messaging and goal setting to ensure that mothers are able to optimize their milk supply during the critical window of opportunity in first 2 weeks after delivery. Research data in the United States indicate that the largest categories of why women stopped breastfeeding were for reasons related to milk supply or concerns that the infant was not getting enough nutrition or gaining enough weight.

Mothers' Facebook posts about infant health: findings from the Grow2Gether study

BACKGROUND

Social media is a common way for mothers to seek advice about their infants. However, little is known about how low-income urban mothers use social media to obtain infant health information and whether this information is consistent with expert pediatric recommendations.

OBJECTIVES

(1) identify the types of health questions asked by low-income mothers of infants in a social media parenting group; (2) describe whether peer answers are consistent with or contradict AAP guidelines; (3) identify the practices that mothers post about that are inconsistent with AAP guidelines.

METHODS

Forty-three low-income mothers were enrolled in Grow2Gether, a private Facebook group intervention focused on infant care and moderated by a psychologist. All health questions posted by mothers were coded thematically; answers to questions from the group were assessed for consistency with American Academy of Pediatrics (AAP) guidelines related to infant feeding, sleep, screen time, and safety. Additionally, all unique posts that contained practices inconsistent with these AAP guidelines were thematically coded.

RESULTS

In total, 215 posts were coded. Participants posted 61 questions related to infant health, most commonly solid food introduction (8/61), teething (8/61), and breastfeeding (7/61). Of the 77 answers given by peers, 6 contradicted guidelines. Separately, mothers had 73 posts demonstrating practices inconsistent with AAP guidelines [safe sleep (43/73) and screen time (21/73)].

CONCLUSIONS

Mothers' Facebook group interactions in the context of an infant care intervention revealed that when mothers posed direct questions regarding infant health, their peers generally gave answers that did not contradict AAP guidelines. In contrast, mothers' posts simply describing sleep and screen time practices commonly contradicted guidelines.

The impact of anticipatory guidance on early childhood caries: a quasi-experimental study

Background

This study evaluated the impact of anticipatory guidance on the caries incidence of 2–3-year-old preschool children and their 4–6-year-old siblings, as well as on their mothers’ oral health literacy, as compared to the conventional Ministry of Health (MOH) programme.

Methods

This quasi-experimental study was conducted at two government dental clinics in Batu Pahat District, Malaysia. The samples comprised of 478 mother-child-sibling trios (233 families in the intervention group, and 245 families in the control group). An oral health package named the Family Dental Wellness Programme (FDWP) was designed to provide dental examinations and oral health education through anticipatory guidance technique to the intervention group at six-month intervals over 3 years. The control group received the standard MOH oral health education activities. The impact of FDWP on net caries increment, caries prevented fraction, and mother’s oral health literacy was assessed after 3 years of intervention.

Results

Children and siblings in the intervention group had a significantly lower net caries increment (0.24 ± SD0.8; 0.20 ± SD0.7) compared to the control group (0.75 ± SD1.2; 0.55 ± SD0.9). The caries prevented fraction for FDWP was 68% for the younger siblings and 63.6% for the older children. The 2–3-year-old children in the intervention group had a significantly lower incidence of white spot lesions than their counterpart (12% vs 25%, p < 0.05). At three-year follow-up, there were significant increments in the oral health literacy scores of mothers in the intervention group compared to the control group.

Conclusion

The FDWP is more effective than the standard MOH programme in terms of children’s and siblings’ caries incidence and mother’s oral health literacy.

Trial registration

ClinicalTrials.gov NCT03478748. Registered on March 26th 2018. Retrospectively registered.

Anticipatory guidance in type 2 diabetes to improve disease management; next steps after basal insulin

The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues. Anticipatory guidance is an individualized, proactive approach to patient education and counseling by a health-care professional to support patients in better coping with problems before they arise. It has been shown to improve disease outcomes in a variety of chronic conditions, including diabetes. While important at all stages, anticipatory guidance may be of particular importance during changes in treatment regimens, and especially during transition to, and escalation of, insulin-based regimens. The aim of this article is to provide advice to physicians on anticipatory guidance for basal-insulin dosing, focusing on appropriate basal-insulin-dose increase and prevention of potentially deleterious basal-insulin doses, so called overbasalization. It also provides an overview of new treatment options for patients with T2D who are not well controlled on basal-insulin therapy, fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists, and advice on the type of anticipatory guidance needed to ensure safe and appropriate switching to these therapies.

Differences in Child Passenger Safety Counseling Frequency and Attitudes by Health Care Provider Specialty

Many children are not being properly restrained in motor vehicles, resulting in unnecessary injury and fatalities. Health care provider (HCP) education is effective at increasing proper child restraint within vehicles. However, differences exist by HCP specialty in regards to frequency of child passenger safety (CPS) counseling. This study of a sample of 255 HCPs examined differences in CPS counseling by HCP specialty (pediatric vs. non-pediatric). HCPs from several upper Midwest states were surveyed about how frequently they provide CPS counseling in their practice by patient age and their attitudes toward CPS-related issues. Pediatric HCPs were twice as likely as non-pediatric HCPs to always provide CPS counseling to parents/guardians of children aged 5 or older. Non-pediatric HCPs were more likely than pediatric HCPs to feel that counseling is ineffective at increasing child seat/booster (p = 0.001) or seat belt use (p = 0.006). Non-pediatric HCPs were more likely than pediatric HCPs to feel there is inadequate time to provide CPS counseling in their practice setting (p = 0.001), and were less likely to know where to refer patients if they have questions regarding CPS issues (0.0291). The differences in HCP attitudes toward CPS counseling provision and the resulting differences in counseling frequency by patient age may contribute to disparities for patients who have limited or no access to pediatric HCPs. Additional research is needed to investigate the rationale for counseling differences seen by HCP specialty and patient age, and the potential effect on child motor vehicle injuries and fatalities.

Knowledge and Attitude about Early Childhood Caries among Pregnant Mothers from Low Socioeconomic Status: A Questionnaire Study

Background:

For health and well-being, oral health is an integral component. Unfortunately, many children are afflicted with dental caries at an early age, even those as young as 12 months. By imparting knowledge, awareness among parents about this disease can bring about reduction of early childhood caries (ECC) at an early stage.

Aim:

The aim of this study was to evaluate knowledge and attitude of expectant mothers about ECC and to reassess the level of knowledge after giving anticipatory guidance.

Materials and Methods:

The questionnaire consisted of 10 questions which were distributed to 100 participants after which anticipatory guidance was given to them. After 15 days, the same questionnaire was distributed among the participants with order of the questions interchanged. Chi-square test was used for statistical analysis.

Results:

There was a significant improvement in the knowledge and attitude about the disease after giving the anticipatory guidance among the participants. P < 0.01 and the result were statistically significant.

Conclusion:

Knowledge and attitude of mothers were found to increase on provision of anticipatory guidance, which was retained even after 15 days.

Diet and anthropometry at 2 years of age following an oral health promotion programme for Australian Aboriginal children and their carers: a randomised controlled trial

There are marked disparities between indigenous and non-indigenous children's diets and oral health. Both diet and oral health are linked to longer-term health problems. We aimed to investigate whether a culturally appropriate multi-faceted oral health promotion intervention reduced Aboriginal children's intake of sugars from discretionary foods at 2 years of age. We conducted a single-blind, parallel-arm randomised controlled trial involving women who were pregnant or had given birth to an Aboriginal child in the previous 6 weeks. The treatment group received anticipatory guidance, Motivational Interviewing, health and dental care for mothers during pregnancy and children at 6, 12 and 18 months. The control group received usual care. The key dietary outcome was the percent energy intake from sugars in discretionary foods (%EI), collected from up to three 24-h dietary recalls by trained research officers who were blind to intervention group. Secondary outcomes included intake of macronutrients, food groups, anthropometric z scores (weight, height, BMI and mid-upper arm circumference) and blood pressure. We enrolled 224 children to the treatment group and 230 to the control group. Intention-to-treat analyses showed that the %EI of sugars in discretionary foods was 1·6 % lower in the treatment group compared with control (95 % CI -3·4, 0·2). This culturally appropriate intervention at four time-points from pregnancy to 18 months resulted in small changes to 2-year-old Aboriginal children's diets, which was insufficient to warrant broader implementation of the intervention. Further consultation with Aboriginal communities is necessary for understanding how to improve the diet and diet-related health outcomes of young Aboriginal children.

Counseling About Skin Cancer Prevention Among Adolescents: What Do Parents Receive From Health Care Providers?

PURPOSE

Adolescence is a high-risk period for ultraviolet radiation exposure, a primary cause of skin cancer later in life. We sought to characterize receipt of health care provider-delivered counseling about skin cancer prevention (SCP) among parents of adolescents.

METHODS

In 2016, we conducted an online survey with a national sample of parents of adolescents aged 11-17 years (n = 1,253). Multivariable logistic regression assessed correlates of receiving counseling from a health care provider about any of the six skin cancer prevention (SCP) topics.

RESULTS

Only half (49%) of parents recalled discussing any SCP topic with their child's provider; the prevalence was highest for sunscreen (39%) and lowest for indoor tanning (3%). Parents had greater odds of receiving counseling if they had a child with more sun-reactive skin (odds ratio [OR] = 1.53); a family history of skin cancer (OR = 1.38); or a higher quality relationship with the provider (OR = 1.47; all p < .05).

CONCLUSIONS

Greater attention to SCP counseling is needed, especially for exposures such as indoor tanning that remain prevalent among adolescents but are rarely addressed in clinical encounters.

Television or unrestricted, unmonitored internet access in the bedroom and body mass index in youth athletes

AIM

To correlate television or unrestricted, unmonitored Internet access in room of sleep with body mass index (BMI).

METHODS

Cross-sectional study of athletes ≤19 years who underwent an injury prevention evaluation. Independent variables included proportion of athletes categorised as overweight or obese who answered positively to American Academy of Pediatrics recommended questions: (i) Do you have a TV in the room where you sleep? (ii) Do you have unrestricted, unmonitored access to the Internet in the room where you sleep?

RESULTS

555 athletes; 324 female; mean age 13.83 ± 2.60. Athletes with a TV in their room of sleep had higher BMI (22.73 vs. 20.54; p < 0.001), slept less hours/week (7.65 vs. 8.12; p = 0.003) and were more likely to be overweight/obese (40.32% vs. 25.52%; p = 0.022). Athletes with unrestricted, unmonitored Internet access in the room of sleep had a higher BMI (21.68 vs. 19.83; p < 0.001), slept fewer hours/week (7.58 vs. 8.60; p < 0.001) and per/weekend (9.00 vs. 9.37; p < 0.001). After adjusting for age and gender, having a TV in the room of sleep remained significantly associated with BMI and WHO criteria for overweight/obesity.

CONCLUSION

Athletes with television in their room of sleep were more likely to have higher BMI and be overweight or obese.

Measuring Unmet Needs for Anticipatory Guidance Among Adolescents at School-Based Health Centers

PURPOSE

Our previously validated Youth Engagement with Health Services survey measures adolescent health care quality. The survey response format allows adolescents to indicate whether their needs for anticipatory guidance were met. Here, we describe the unmet needs for anticipatory guidance reported by adolescents and identify adolescent characteristics related to unmet needs for guidance.

METHODS

We administered the survey in 2013-2014 to 540 adolescents who used school-based health centers in Colorado and New Mexico. A participant was considered to have unmet needs for anticipatory guidance if they indicated that guidance was needed on a given topic but not received or guidance was received that did not meet their needs. We calculated proportions of students with unmet needs for guidance and examined associations between unmet needs for guidance and participant characteristics using the chi-square test and logistic regression.

RESULTS

Among participants, 47.4% reported at least one unmet need for guidance from a health care provider in the past year. Topics with the highest proportions of adolescents reporting unmet needs included healthy diet (19.5%), stress (18.0%), and body image (17.0%). In logistic regression modeling, adolescents at risk for depression and those with minority or immigrant status had increased unmet needs for guidance. Adolescents reporting receipt of patient-centered care were less likely to report unmet needs for guidance.

CONCLUSIONS

The Youth Engagement with Health Services survey provides needs-based measurement of anticipatory guidance received that may support targeted improvements in the delivery of adolescent preventive counseling. Interventions to improve patient-centered care and preventive counseling for vulnerable youth populations may be warranted.

Long-Acting Reversible Contraception: An Essential Guide for Pediatric Primary Care Providers

Long-acting reversible contraception (LARC) methods are 20% more effective than traditional contraceptives and are recommended by the American Academy of Pediatrics and American College of Obstetrics and Gynecology as first-line contraception for adolescent girls. Large studies show that LARC use reduces unintended pregnancies, increases user satisfaction, and prolongs duration of use. This article prepares the primary care provider (PCP) with knowledge on safety, efficacy, eligibility, confidentiality, anticipatory guidance, how to find a LARC provider, and guidance on common side effects so the PCP can confidently counsel adolescent patients on LARC methods.

Surgical Management of Large Radicular Cyst Associated with Mandibular Deciduous Molar Using Platelet-rich Fibrin Augmentation: A Rare Case Report

Radicular cysts arising from deciduous teeth are rare and usually cause a large bony defect. Autologous platelet-rich fibrin (PRF) is an easily available healing biomaterial in oral surgical defect with the new perspective of accelerated healing of a large bony defect. The present case is of unusually large radicular associated with neglected carious mandibular deciduous second molar in 10-year-old girl and its surgical management with PRF augmentation as a healing biomaterial in the bony defect. One-year follow-up showed uneventful healing and eruption of succedaneous tooth. Healing was relatively faster and facilitated by PRF placement. Furthermore, the importance of anticipatory guidance about the treatment of diseased primary teeth and their preservation gets highlighted.

Adolescents' Self-Reported Recall of Anticipatory Guidance Provided During Well-Visits at Nine Medical Clinics in San Diego, California, 2009-2011

PURPOSE

Anticipatory guidance (AG) is recommended for adolescent well care. AG recall is important in the event sequence that might lead to behavioral change, reduced health risk, and improved health. We assessed factors influencing adolescents' self-reported recall of specific AG topics.

METHODS

Through convenience sampling of nine clinics in San Diego, California, 872 adolescents (429 aged 11-13 years; 443 aged 14-17 years) who had received well visits completed standardized surveys between 2009 and 2011. Adolescents were asked to report recall of either 17 or 23 age-appropriate AG topics that were analyzed in five categories (health maintenance; social/emotional, safety/violence; smoking/substance abuse, and puberty/sexual health); a summary score for all categories was developed. Summary scores' associations with demographic variables, visit characteristics (including having time without parents present [private time]), clinic procedures, and lead physician attitudes were assessed.

RESULTS

AG recall was independently associated with adolescents having private time with clinicians, completing previsit questionnaires, reporting the well visit was helpful, and the well visit lasting at least 10 minutes. Higher summary recall scores were observed among adolescents who received care in clinics providing AG at both sick and well visits and having policies encouraging private time. Clinic electronic medical record use for AG prompts was associated with recall of fewer topics.

CONCLUSIONS

To increase adolescents' AG recall and potentially foster behavior change, our results suggest medical providers should adopt procedures advocated by professional societies, including assuring adolescents receive private time during visits, increasing visit time during well visits, using patient-completed questionnaires, and providing AG during all visits.

Experience with genetic counseling: the adolescent perspective

Adolescence is a complex period of development that involves creating a sense of identity, autonomy, relationships and values. This stage of adjustment can be complicated by having a genetic condition. Genetic counseling can play an important role in providing information and support to this patient population; however, resources and guidelines are currently limited. In order to appropriately establish genetic counseling approaches and resource development, we investigated the experiences and perspectives of adolescents with a genetic condition with respect to their genetic counseling interactions. Using a qualitative exploratory approach, eleven semi-structured interviews were conducted with adolescents diagnosed with a genetic condition who received genetic counseling between the ages of 12 and 18 years at The Hospital for Sick Children. Transcripts were analyzed thematically using qualitative content analysis, from which three major interrelated themes emerged: 1) understanding the genetic counselor's role; 2) increasing perceived personal control; and 3) adolescent-specific factors influencing adaptation to one's condition. Additionally, a list of suggested tools and strategies for genetic counseling practice were elucidated. Our findings can contribute to the development of an adolescent-focused framework to enhance emerging genetic counseling approaches for this patient population, and can also facilitate the transition process from pediatric to adult care within patient and family-centered contexts.

Early Literacy Promotion in the Digital Age

School readiness and educational success is strongly mediated by early literacy skills. In both exam-room and community-based settings, child-health providers can affect the trajectory of early literacy by implementing evidence-based, culturally appropriate interventions that support child development, parenting skills, and child-caregiver interaction. Despite limited research on the subject, these interventions should also attend to the evolving role of digital-media exposure (both positive and negative) on the developmental health of children.

Transition Planning for the College Bound Adolescent with a Mental Health Disorder

Health promotion, disease prevention and anticipatory guidance are the hallmarks of nursing practice, particularly in pediatrics. While there is a wealth of information on anticipatory guidance for the pediatric patient at different ages and developmental stages, there is a paucity of information on anticipatory guidance for the adolescent and emerging adult in transitioning to manage their own health care. While an established need for anticipatory guidance and a transition plan from pediatric to adult health care is apparent for youth routinely followed for significant medical, intellectual, or developmental conditions, a group particularly vulnerable to destabilization of their health as they transition to self-directed adult health care management is composed of youth with mental health disorders. The risk for destabilization increases as they move away from social supports to the university setting. This article reviews available literature on anticipatory guidance for the college bound adolescent with a mental health disorder and makes recommendations for transition planning including examining the college and community services that would support mental health as well as personal choices regarding lifestyle habits while attending the university. Recommendations are made for nurses to be the leaders in filling this anticipatory guidance gap in preparing youth with mental health disorders for a successful transition to and through college life.

Normal Vulvovaginal Health in Adolescents

As adolescence is often the first time a woman will see a gynecologist, it is important for health care providers to understand and be capable of explaining the changes that occur to a young woman during these years. Many adolescents and their caretakers who seek gynecologic care for what they consider vulvovaginal abnormalities may be misinterpreting completely normal changes; education and reassurance are the best treatment in these cases. Most medical literature on vulvovaginal health focuses on abnormalities and there is a paucity of information on what is considered "normal." This goal of this review is to describe normal anatomic and physiologic vulvovaginal changes that occur during the adolescent years, as well as to offer advice on how to educate and reassure young women during this vulnerable time.

Do the more caries in early primary dentition indicate the more caries in permanent dentition? Results of a 5-years follow-up study in rural-district

Aim:

In the deprived communities with high caries incidence, determination of high-risk children in early age is a valuable tool to apply the individual and/or community-level preventive measures. The purpose of this 5-years follow-up study was to examine the relationship between early caries occurrence on primary incisors and the future caries occurrence on both first permanent molars and all permanent dentition in the children living in rural Turkey.

Materials and Methods:

Total 34 children living in rural-districts of southeastern Anatolia were included, and divided in both test (caries positive for maxillary primary incisors) and control groups (caries free on the same teeth). During the 5-years they were examined annually regarding new caries occurrence in either first permanent molars for the Decayed, Missing, Filled Tooth Index [(DMF(T)_[6])] or all permanent dentition (DMF(T)).

Results:

At the beginning of the study, the age range of the children was 3 to 5 (mean ± St dv; 4.03 1.24), and d(t)_{[max 1,2]} and df(t) indices for the deciduous dentition of test and control groups were 2.65 ± 0.78; 4.29 ± 2.08 and 0; 0.24 ± 0.43, respectively. After 5-years mean DMF(T)_[6] and total DMF(T) for test and control groups were 1.88 ± 0.66; 3.12 ± 0.69 and 0.47 ± 0.62; 0.65 ± 0.93, respectively (for each parameters the difference was statistically significant P < 0.01). For test group the number of caries on primary-incisors (d(t)_{[max 1,2]}) was correlated with the DMF(T)_[6] (r = 0.80) and DMF(T) (r = 0.59).

Conclusion:

The caries-information including the early primary incisors could be helpful in identifying children with increased risk so that preventive measures could be directed at those who fit the high-risk-caries profile.

Injury prevention: opportunities in the emergency department

Because injury is the leading cause of morbidity and mortality in young patients, emergency departments have a significant opportunity to provide injury-prevention interventions at a teachable moment. The emergency department has the ability to survey injuries in the community, use the hospital setting to screen patients, provide products, offer resources to assist families within this setting to change their risky behaviors, and connect families to community resources. With a thoughtful, collaborative approach, emergency departments are an excellent setting within which to promote injury prevention among patients and families.

Preventing choking and suffocation in children

Choking, suffocation and strangulation cause serious unintentional injuries in children and are leading causes of unintentional death in infants and toddlers. Nearly all choking, suffocation and strangulation deaths and injuries are preventable. The present statement reviews definitions, epidemiology and effective prevention strategies for these injuries. Recommendations that combine approaches for improving safety, including research, surveillance, legislation and standards, product design and education, are made. Paediatric health care providers should be encouraging parents and other caregivers to learn cardiopulmonary resuscitation (CPR) and choking first aid, as well as offering anticipatory, age-appropriate guidance to prevent these injuries at regular health visits.

Breastfeeding: Nature's Safety Net

Breastfeeding is a natural safety-net for the first few months in order to give the child a fairer start to life. The American Academy of Pediatric Dentistry recognizes the distinct nutritional advantages of human milk for infants and endorsed the position of the American Academy of Pediatrics on the promotion of breastfeeding. It therefore calls for increase in need to negotiate the roles and responsibilities of pediatric dentists to eliminate the existing gaps in preventive care and anticipatory guidance. The objective of this evidence-based review is to explore the beneficial roles of breastfeeding in orofacial growth and development and endorse the same through anticipatory guidance.

How to cite this article: Agarwal M, Ghousia S, Konde S, Raj S. Breastfeeding: Nature’s Safety Net. Int J Clin Pediatr Dent 2012;5(1):49-53.

Dental home: Patient centered dentistry

Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.

Reach of a kiosk-based pediatric injury prevention program

While controlled trials are important for determining the efficacy of public health programs, implementation studies are critical to guide the translation of efficacious programs to general practice. To implement an evidence-based injury prevention program and examine program use and completion rates in two implementation phases, Safe N' Sound, an evidence-based program, was implemented in five pediatric clinics. Data on program use were collected from program files and patient census data. Program use averaged 12.1% of eligible patients during implementation and 9.5% during the continuation phase. Program completion averaged 9.7% and 6.5%, respectively. Findings from this study can inform the dissemination of evidence-based public health programs, particularly in practice-based clinical settings.

Genetic issues in the care of the adolescent patient

Genetic issues are important in the primary care of adolescents. A genetic diagnosis may not be made until adolescence, when the teenager presents with the first signs or symptoms of the condition. The physician's knowledge of the natural history of a genetic disease will aid in the anticipatory guidance for teens and their parents. The physician may be called upon to advise the patient regarding hormone therapy or contraception. The paediatrician may initiate topics such as sexuality and sex education for the developmentally delayed patient. The paediatrician is also the advocate for the teenager, who must gain independence from the family in medical as well as other aspects of life. This article examines some of these issues, using cases to illustrate the genetic problems and approaches in the care of the teenaged patient.