Tara Haelle

A longer dwell time for peripherally inserted central catheters in newborns does not appear to increase the risk of central line-associated bloodstream infections (CLABSIs), according to a recent study.

“Replacing catheters unnecessarily is dangerous. Our data indicate that clinicians should not routinely replace uninfected peripherally inserted central catheters (PICC) for fear of infection,” Dr. Rachel G. Greenberg of the Duke University School of Medicine in Durham, N.C., and her associates reported online.

“Our finding of a lack of association for PICC line infections with dwell time suggests that clinicians should focus their efforts to reduce CLABSI on both proper line maintenance and timely central line removal when the line is no longer needed,” the authors wrote (Pediatrics 2015 Nov. 16 [doi: 10.1542/peds.2015-0573]).

The risk for CLABSIs with tunneled catheters, however, did increase significantly in weeks 7 and 9, the researchers found.

“Our data suggest that although there may be compelling reasons to leave a tunneled catheter in place, daily consideration should be given to the necessity of a tunneled catheter weighed against the increased risk for infection that develops in the sixth week of dwell time,” Dr. Greenberg and her colleagues wrote.

The researchers retrospectively analyzed the rate of CLABSIs among 13,327 infants, with a median age of 29 weeks, in 141 NICUs in 13 states from September 2011 to August 2013. The infants had 15,567 catheters, 93% of which were PICCs and 7% of which were tunneled catheters, for a total of 256,088 catheter days.

The median dwell time for PICCs was 11 days, compared to 25 days for the tunneled catheters, a significant difference. A total of 87 PICCs and 124 tunneled catheters had dwell times over 10 weeks.

CLABSIs occurred 2.4 times more often with tunneled catheters (3.5%) than with PICCs (1.4%), but CLABSI rates varied considerably across different NICUs. Just under half the NICUs (47%) had no CLABSIs. With an overall rate of 0.93 CLABSIs per 1,000 catheter days, the researchers did not find a positive correlation between dwell time and CLABSI risk from PICCs.

The risk of CLABSI for tunneled catheters was significantly higher during weeks 7 (hazard ratio: 4.0) and 9 (HR: 4.7), compared with week 1. The overall risk of CLABSIs was significantly four times greater for infants born from 26 to 29 weeks (HR: 3.9) and six times greater for infants born before 26 weeks (HR: 6.1), but preterm infants had no higher risk of CLABSIs from tunneled catheters.

“We postulate that the significant maturational changes in the immune system that occur in the early neonatal period, particularly in premature infants, may lead to decreased risk of infection as the infant ages with the central line in place,” the authors wrote. “Increased enteral feeds and decreased acuity of illness over time may also lead to fewer times the line is accessed and therefore less frequent opportunities to introduce infection,” they continued. “Finally, maturation of the gastrointestinal system in older infants may lead to less translocation of bacteria and decreased risk for infection.”

The research was funded by the National Institutes of Health, the Health Research & Educational Trust. Dr. Smith receives research funding from Cempra Pharmaceuticals and other industry for pediatric drug development.

A longer dwell time for peripherally inserted central catheters in newborns does not appear to increase the risk of central line-associated bloodstream infections (CLABSIs), according to a recent study.

“Replacing catheters unnecessarily is dangerous. Our data indicate that clinicians should not routinely replace uninfected peripherally inserted central catheters (PICC) for fear of infection,” Dr. Rachel G. Greenberg of the Duke University School of Medicine in Durham, N.C., and her associates reported online.

“Our finding of a lack of association for PICC line infections with dwell time suggests that clinicians should focus their efforts to reduce CLABSI on both proper line maintenance and timely central line removal when the line is no longer needed,” the authors wrote (Pediatrics 2015 Nov. 16 [doi: 10.1542/peds.2015-0573]).

The risk for CLABSIs with tunneled catheters, however, did increase significantly in weeks 7 and 9, the researchers found.

“Our data suggest that although there may be compelling reasons to leave a tunneled catheter in place, daily consideration should be given to the necessity of a tunneled catheter weighed against the increased risk for infection that develops in the sixth week of dwell time,” Dr. Greenberg and her colleagues wrote.

The researchers retrospectively analyzed the rate of CLABSIs among 13,327 infants, with a median age of 29 weeks, in 141 NICUs in 13 states from September 2011 to August 2013. The infants had 15,567 catheters, 93% of which were PICCs and 7% of which were tunneled catheters, for a total of 256,088 catheter days.

The median dwell time for PICCs was 11 days, compared to 25 days for the tunneled catheters, a significant difference. A total of 87 PICCs and 124 tunneled catheters had dwell times over 10 weeks.

CLABSIs occurred 2.4 times more often with tunneled catheters (3.5%) than with PICCs (1.4%), but CLABSI rates varied considerably across different NICUs. Just under half the NICUs (47%) had no CLABSIs. With an overall rate of 0.93 CLABSIs per 1,000 catheter days, the researchers did not find a positive correlation between dwell time and CLABSI risk from PICCs.

The risk of CLABSI for tunneled catheters was significantly higher during weeks 7 (hazard ratio: 4.0) and 9 (HR: 4.7), compared with week 1. The overall risk of CLABSIs was significantly four times greater for infants born from 26 to 29 weeks (HR: 3.9) and six times greater for infants born before 26 weeks (HR: 6.1), but preterm infants had no higher risk of CLABSIs from tunneled catheters.

“We postulate that the significant maturational changes in the immune system that occur in the early neonatal period, particularly in premature infants, may lead to decreased risk of infection as the infant ages with the central line in place,” the authors wrote. “Increased enteral feeds and decreased acuity of illness over time may also lead to fewer times the line is accessed and therefore less frequent opportunities to introduce infection,” they continued. “Finally, maturation of the gastrointestinal system in older infants may lead to less translocation of bacteria and decreased risk for infection.”

The research was funded by the National Institutes of Health, the Health Research & Educational Trust. Dr. Smith receives research funding from Cempra Pharmaceuticals and other industry for pediatric drug development.

A longer dwell time for peripherally inserted central catheters in newborns does not appear to increase the risk of central line-associated bloodstream infections (CLABSIs), according to a recent study.

“Replacing catheters unnecessarily is dangerous. Our data indicate that clinicians should not routinely replace uninfected peripherally inserted central catheters (PICC) for fear of infection,” Dr. Rachel G. Greenberg of the Duke University School of Medicine in Durham, N.C., and her associates reported online.

“Our finding of a lack of association for PICC line infections with dwell time suggests that clinicians should focus their efforts to reduce CLABSI on both proper line maintenance and timely central line removal when the line is no longer needed,” the authors wrote (Pediatrics 2015 Nov. 16 [doi: 10.1542/peds.2015-0573]).

The risk for CLABSIs with tunneled catheters, however, did increase significantly in weeks 7 and 9, the researchers found.

“Our data suggest that although there may be compelling reasons to leave a tunneled catheter in place, daily consideration should be given to the necessity of a tunneled catheter weighed against the increased risk for infection that develops in the sixth week of dwell time,” Dr. Greenberg and her colleagues wrote.

The researchers retrospectively analyzed the rate of CLABSIs among 13,327 infants, with a median age of 29 weeks, in 141 NICUs in 13 states from September 2011 to August 2013. The infants had 15,567 catheters, 93% of which were PICCs and 7% of which were tunneled catheters, for a total of 256,088 catheter days.

The median dwell time for PICCs was 11 days, compared to 25 days for the tunneled catheters, a significant difference. A total of 87 PICCs and 124 tunneled catheters had dwell times over 10 weeks.

CLABSIs occurred 2.4 times more often with tunneled catheters (3.5%) than with PICCs (1.4%), but CLABSI rates varied considerably across different NICUs. Just under half the NICUs (47%) had no CLABSIs. With an overall rate of 0.93 CLABSIs per 1,000 catheter days, the researchers did not find a positive correlation between dwell time and CLABSI risk from PICCs.

The risk of CLABSI for tunneled catheters was significantly higher during weeks 7 (hazard ratio: 4.0) and 9 (HR: 4.7), compared with week 1. The overall risk of CLABSIs was significantly four times greater for infants born from 26 to 29 weeks (HR: 3.9) and six times greater for infants born before 26 weeks (HR: 6.1), but preterm infants had no higher risk of CLABSIs from tunneled catheters.

“We postulate that the significant maturational changes in the immune system that occur in the early neonatal period, particularly in premature infants, may lead to decreased risk of infection as the infant ages with the central line in place,” the authors wrote. “Increased enteral feeds and decreased acuity of illness over time may also lead to fewer times the line is accessed and therefore less frequent opportunities to introduce infection,” they continued. “Finally, maturation of the gastrointestinal system in older infants may lead to less translocation of bacteria and decreased risk for infection.”

The research was funded by the National Institutes of Health, the Health Research & Educational Trust. Dr. Smith receives research funding from Cempra Pharmaceuticals and other industry for pediatric drug development.

Rates of catheter-associated bloodstream infections among preterm newborns did not differ based on the use of peripherally inserted central catheters versus umbilical venous catheters, according to a study published online in Pediatrics.

“To clarify which mode of primary access is better for reducing CABSI [catheter-associated bloodstream infection] as well as other short- and long-term complications, a well-designed, adequately powered, randomized clinical trial will be needed,” wrote Dr. Mohamed Shalabi of Mount Sinai Hospital in Toronto and his associates (Pediatrics. 2015 Nov 16;136[6]:1073-9. doi: 10.1542/peds.2015-2710).

The researchers retrospectively compared the rates of CABSI among 540 infants born before 30 weeks’ gestation and admitted to neonatal units in the Canadian Neonatal Network between January 2010 and December 2013.

Three groups were compared: 180 infants who received a peripherally inserted central catheter (PICC) on their first day after birth; 180 infants, matched to the PICC group by gestational age, birth weight, and sex, who received an umbilical venous catheter (UVC) on their first day after birth; and 180 infants similarly matched to the PICC group who first received a UVC that was then changed to a PICC after at least 4 days.

The UVC + PICC group had the longest total catheter duration with 4,515 catheter days, compared with 3,012 days in the PICC group and 1,532 days in the UVC group. In the PICC group, the 37 infections translated to a rate of 9.3 infants with CABSI per 1,000 catheter days, compared with 12 CABSI episodes at a rate of 7.8 infants with CABSI per 1,000 catheter days in the UVC group. The UVC + PICC group’s 45 infections meant a rate of 8.2 infants with CABSI infections per 1,000 catheter days, resulting in no significant difference among the three groups’ CABSI rates (P greater than .05).

“Multivariate analyses revealed a higher incidence of infants with LOS [length of stay] per 1,000 catheter days in the PICC group versus the UVC + PICC group; however, this may be reflective of total catheter days,” the researchers reported. The lowest rate of late-onset sepsis, 12%, was in the UVC group, compared with 22% in the PICC group and 23% in the UVC + PICC group.

“Despite an equal number of patients in each group, the catheter days were significantly higher in both the PICC groups, compared with the UVC alone group,” Dr. Shalabi’s team reported. “This is probably a reflection of the clinical practice of removing UVCs by 5-7 days after birth, whereas PICCs are removed mostly when not needed or when complications occur.”

The analysis is limited by a lack of information regarding the reasons for use of one catheter over another and the fact that some patients had multiple infections while the PICC remained. “This reflects practice variations because in some cases a PICC is not removed after the first episode of infection and we do not have data on the reasoning behind such an occurrence,” the authors wrote.

The authors reported no relevant financial disclosures. The research did not receive explicit external funding, but the program and researchers receive some support from the Canadian Institutes of Health Research.

Rates of catheter-associated bloodstream infections among preterm newborns did not differ based on the use of peripherally inserted central catheters versus umbilical venous catheters, according to a study published online in Pediatrics.

“To clarify which mode of primary access is better for reducing CABSI [catheter-associated bloodstream infection] as well as other short- and long-term complications, a well-designed, adequately powered, randomized clinical trial will be needed,” wrote Dr. Mohamed Shalabi of Mount Sinai Hospital in Toronto and his associates (Pediatrics. 2015 Nov 16;136[6]:1073-9. doi: 10.1542/peds.2015-2710).

The researchers retrospectively compared the rates of CABSI among 540 infants born before 30 weeks’ gestation and admitted to neonatal units in the Canadian Neonatal Network between January 2010 and December 2013.

Three groups were compared: 180 infants who received a peripherally inserted central catheter (PICC) on their first day after birth; 180 infants, matched to the PICC group by gestational age, birth weight, and sex, who received an umbilical venous catheter (UVC) on their first day after birth; and 180 infants similarly matched to the PICC group who first received a UVC that was then changed to a PICC after at least 4 days.

The UVC + PICC group had the longest total catheter duration with 4,515 catheter days, compared with 3,012 days in the PICC group and 1,532 days in the UVC group. In the PICC group, the 37 infections translated to a rate of 9.3 infants with CABSI per 1,000 catheter days, compared with 12 CABSI episodes at a rate of 7.8 infants with CABSI per 1,000 catheter days in the UVC group. The UVC + PICC group’s 45 infections meant a rate of 8.2 infants with CABSI infections per 1,000 catheter days, resulting in no significant difference among the three groups’ CABSI rates (P greater than .05).

“Multivariate analyses revealed a higher incidence of infants with LOS [length of stay] per 1,000 catheter days in the PICC group versus the UVC + PICC group; however, this may be reflective of total catheter days,” the researchers reported. The lowest rate of late-onset sepsis, 12%, was in the UVC group, compared with 22% in the PICC group and 23% in the UVC + PICC group.

“Despite an equal number of patients in each group, the catheter days were significantly higher in both the PICC groups, compared with the UVC alone group,” Dr. Shalabi’s team reported. “This is probably a reflection of the clinical practice of removing UVCs by 5-7 days after birth, whereas PICCs are removed mostly when not needed or when complications occur.”

The analysis is limited by a lack of information regarding the reasons for use of one catheter over another and the fact that some patients had multiple infections while the PICC remained. “This reflects practice variations because in some cases a PICC is not removed after the first episode of infection and we do not have data on the reasoning behind such an occurrence,” the authors wrote.

The authors reported no relevant financial disclosures. The research did not receive explicit external funding, but the program and researchers receive some support from the Canadian Institutes of Health Research.

Rates of catheter-associated bloodstream infections among preterm newborns did not differ based on the use of peripherally inserted central catheters versus umbilical venous catheters, according to a study published online in Pediatrics.

“To clarify which mode of primary access is better for reducing CABSI [catheter-associated bloodstream infection] as well as other short- and long-term complications, a well-designed, adequately powered, randomized clinical trial will be needed,” wrote Dr. Mohamed Shalabi of Mount Sinai Hospital in Toronto and his associates (Pediatrics. 2015 Nov 16;136[6]:1073-9. doi: 10.1542/peds.2015-2710).

The researchers retrospectively compared the rates of CABSI among 540 infants born before 30 weeks’ gestation and admitted to neonatal units in the Canadian Neonatal Network between January 2010 and December 2013.

Three groups were compared: 180 infants who received a peripherally inserted central catheter (PICC) on their first day after birth; 180 infants, matched to the PICC group by gestational age, birth weight, and sex, who received an umbilical venous catheter (UVC) on their first day after birth; and 180 infants similarly matched to the PICC group who first received a UVC that was then changed to a PICC after at least 4 days.

The UVC + PICC group had the longest total catheter duration with 4,515 catheter days, compared with 3,012 days in the PICC group and 1,532 days in the UVC group. In the PICC group, the 37 infections translated to a rate of 9.3 infants with CABSI per 1,000 catheter days, compared with 12 CABSI episodes at a rate of 7.8 infants with CABSI per 1,000 catheter days in the UVC group. The UVC + PICC group’s 45 infections meant a rate of 8.2 infants with CABSI infections per 1,000 catheter days, resulting in no significant difference among the three groups’ CABSI rates (P greater than .05).

“Multivariate analyses revealed a higher incidence of infants with LOS [length of stay] per 1,000 catheter days in the PICC group versus the UVC + PICC group; however, this may be reflective of total catheter days,” the researchers reported. The lowest rate of late-onset sepsis, 12%, was in the UVC group, compared with 22% in the PICC group and 23% in the UVC + PICC group.

“Despite an equal number of patients in each group, the catheter days were significantly higher in both the PICC groups, compared with the UVC alone group,” Dr. Shalabi’s team reported. “This is probably a reflection of the clinical practice of removing UVCs by 5-7 days after birth, whereas PICCs are removed mostly when not needed or when complications occur.”

The analysis is limited by a lack of information regarding the reasons for use of one catheter over another and the fact that some patients had multiple infections while the PICC remained. “This reflects practice variations because in some cases a PICC is not removed after the first episode of infection and we do not have data on the reasoning behind such an occurrence,” the authors wrote.

The authors reported no relevant financial disclosures. The research did not receive explicit external funding, but the program and researchers receive some support from the Canadian Institutes of Health Research.

Nulliparous pregnant women with an unfavorable cervix who were induced after 39 weeks’ gestation were more likely to have a cesarean delivery than were women undergoing expectant management, but the ceserean rate was not doubled, according to a new study.

The randomized clinical trial of 162 pregnant women was powered only to detect a twofold difference in cesearean rates since that rate has been cited in older observational studies and some guidelines as evidence against elective induction, according to Dr. Nathaniel R. Miller of the Carl R. Darnall Army Medical Center in Fort Hood, Tex., and his associates.

“Clearly, less-modest increases in the cesarean delivery rate may be clinically important, and future studies should be powered to detect smaller differences in the cesarean delivery rate between induction and expectant management,” the researchers wrote.

Martin Valigursky/Thinkstock.com

Researchers randomized 162 nulliparous pregnant women to elective induction of labor or expectant management when they were between 38 weeks 0 days and 38 weeks 6 days of gestation. The women were at least 18 years old with a singleton pregnancy with cephalic presentation, and a Bishop score no higher than 5. Inductions occurred within a week of enrollment, which ran from March 2010 to February 2014, but no women were induced before 39 weeks 0 days (Obstet Gynecol. 2015;126:1258-64).

Cesarean delivery was indicated if at least one of the following was present: nonreassuring fetal status (persistent category II or III); active phase arrest of dilation; arrest of descent in the second stage of labor; or failed induction of labor.

Among the 82 women assigned to induction, 3 did not receive the intervention, 2% were admitted in spontaneous labor, and 30.5% had a cesarean delivery. Among 80 women randomized to expectant management, after excluding 1 lost to follow-up, 44% were admitted in spontaneous labor and 17.7% had a cesarean delivery.

The risk of cesarean delivery between the groups, however, was not statistically significant (relative risk, 1.72; 95% confidence interval 0.96-3.06). Neither postpartum length of stay nor indications for cesarean delivery significantly differed between the two groups, though maternal total hospital length of stay was 10 hours longer in the induction group and inductions for hypertensive disorders were greater in the expectant management group.

“The consistent message from the expanding literature on this topic is that there are and will continue to be important trade-offs to weigh in the balance, especially when it comes to discussing the risk of cesarean delivery with induction in this seemingly highest-risk population of nulliparous women with an unfavorable cervix,” the resarchers wrote.

Additionally, the study defined active phase arrest of dilation as “2 hours of no cervical change once 4 cm or more dilation had been reached after rupture of membranes,” rather than the 4 hours recommended by guidelines for prevention of the first cesarean delivery, published in November 2012 by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal Fetal Medicine, and the American College of Obstetricians and Gynecologists. Since the most common indication for cesarean delivery in the induction group was arrest of dilation, use of the 4-hour criteria “would have resulted in a reduction in the cesarean delivery rate for the induction of labor arm to 20% and the expectant management arm to 15%,” the researchers noted.

The researchers reported having no financial disclosures.

Nulliparous pregnant women with an unfavorable cervix who were induced after 39 weeks’ gestation were more likely to have a cesarean delivery than were women undergoing expectant management, but the ceserean rate was not doubled, according to a new study.

The randomized clinical trial of 162 pregnant women was powered only to detect a twofold difference in cesearean rates since that rate has been cited in older observational studies and some guidelines as evidence against elective induction, according to Dr. Nathaniel R. Miller of the Carl R. Darnall Army Medical Center in Fort Hood, Tex., and his associates.

“Clearly, less-modest increases in the cesarean delivery rate may be clinically important, and future studies should be powered to detect smaller differences in the cesarean delivery rate between induction and expectant management,” the researchers wrote.

Martin Valigursky/Thinkstock.com

Researchers randomized 162 nulliparous pregnant women to elective induction of labor or expectant management when they were between 38 weeks 0 days and 38 weeks 6 days of gestation. The women were at least 18 years old with a singleton pregnancy with cephalic presentation, and a Bishop score no higher than 5. Inductions occurred within a week of enrollment, which ran from March 2010 to February 2014, but no women were induced before 39 weeks 0 days (Obstet Gynecol. 2015;126:1258-64).

Cesarean delivery was indicated if at least one of the following was present: nonreassuring fetal status (persistent category II or III); active phase arrest of dilation; arrest of descent in the second stage of labor; or failed induction of labor.

Among the 82 women assigned to induction, 3 did not receive the intervention, 2% were admitted in spontaneous labor, and 30.5% had a cesarean delivery. Among 80 women randomized to expectant management, after excluding 1 lost to follow-up, 44% were admitted in spontaneous labor and 17.7% had a cesarean delivery.

The risk of cesarean delivery between the groups, however, was not statistically significant (relative risk, 1.72; 95% confidence interval 0.96-3.06). Neither postpartum length of stay nor indications for cesarean delivery significantly differed between the two groups, though maternal total hospital length of stay was 10 hours longer in the induction group and inductions for hypertensive disorders were greater in the expectant management group.

“The consistent message from the expanding literature on this topic is that there are and will continue to be important trade-offs to weigh in the balance, especially when it comes to discussing the risk of cesarean delivery with induction in this seemingly highest-risk population of nulliparous women with an unfavorable cervix,” the resarchers wrote.

Additionally, the study defined active phase arrest of dilation as “2 hours of no cervical change once 4 cm or more dilation had been reached after rupture of membranes,” rather than the 4 hours recommended by guidelines for prevention of the first cesarean delivery, published in November 2012 by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal Fetal Medicine, and the American College of Obstetricians and Gynecologists. Since the most common indication for cesarean delivery in the induction group was arrest of dilation, use of the 4-hour criteria “would have resulted in a reduction in the cesarean delivery rate for the induction of labor arm to 20% and the expectant management arm to 15%,” the researchers noted.

The researchers reported having no financial disclosures.

Nulliparous pregnant women with an unfavorable cervix who were induced after 39 weeks’ gestation were more likely to have a cesarean delivery than were women undergoing expectant management, but the ceserean rate was not doubled, according to a new study.

The randomized clinical trial of 162 pregnant women was powered only to detect a twofold difference in cesearean rates since that rate has been cited in older observational studies and some guidelines as evidence against elective induction, according to Dr. Nathaniel R. Miller of the Carl R. Darnall Army Medical Center in Fort Hood, Tex., and his associates.

“Clearly, less-modest increases in the cesarean delivery rate may be clinically important, and future studies should be powered to detect smaller differences in the cesarean delivery rate between induction and expectant management,” the researchers wrote.

Martin Valigursky/Thinkstock.com

Researchers randomized 162 nulliparous pregnant women to elective induction of labor or expectant management when they were between 38 weeks 0 days and 38 weeks 6 days of gestation. The women were at least 18 years old with a singleton pregnancy with cephalic presentation, and a Bishop score no higher than 5. Inductions occurred within a week of enrollment, which ran from March 2010 to February 2014, but no women were induced before 39 weeks 0 days (Obstet Gynecol. 2015;126:1258-64).

Cesarean delivery was indicated if at least one of the following was present: nonreassuring fetal status (persistent category II or III); active phase arrest of dilation; arrest of descent in the second stage of labor; or failed induction of labor.

Among the 82 women assigned to induction, 3 did not receive the intervention, 2% were admitted in spontaneous labor, and 30.5% had a cesarean delivery. Among 80 women randomized to expectant management, after excluding 1 lost to follow-up, 44% were admitted in spontaneous labor and 17.7% had a cesarean delivery.

The risk of cesarean delivery between the groups, however, was not statistically significant (relative risk, 1.72; 95% confidence interval 0.96-3.06). Neither postpartum length of stay nor indications for cesarean delivery significantly differed between the two groups, though maternal total hospital length of stay was 10 hours longer in the induction group and inductions for hypertensive disorders were greater in the expectant management group.

“The consistent message from the expanding literature on this topic is that there are and will continue to be important trade-offs to weigh in the balance, especially when it comes to discussing the risk of cesarean delivery with induction in this seemingly highest-risk population of nulliparous women with an unfavorable cervix,” the resarchers wrote.

Additionally, the study defined active phase arrest of dilation as “2 hours of no cervical change once 4 cm or more dilation had been reached after rupture of membranes,” rather than the 4 hours recommended by guidelines for prevention of the first cesarean delivery, published in November 2012 by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal Fetal Medicine, and the American College of Obstetricians and Gynecologists. Since the most common indication for cesarean delivery in the induction group was arrest of dilation, use of the 4-hour criteria “would have resulted in a reduction in the cesarean delivery rate for the induction of labor arm to 20% and the expectant management arm to 15%,” the researchers noted.

The researchers reported having no financial disclosures.

WASHINGTON – Limiting the amount of full contact tackling that occurs in high school football practice reduced the rate of sports-related concussions that the athletes experienced, a prospective study showed.

“Something as simple as saying they can’t tackle all the time, limiting the amount of minutes each month, reduced the incidence,” Timothy A. McGuine, Ph.D., of the University of Wisconsin, Madison, said at the American Academy of Pediatrics annual meeting.

©Majoros Laszlo/thinkstockphotos.com

“The majority of sports-related concussions sustained in high school football practice occurred during full contact activities,” he said. “The rate of sports-related concussions sustained in high school football practice was more than twice as high in the two seasons prior to a rule change limiting the amount and duration of full contact activities.”

In their study, Dr. McGuine and his associates tested the effects of a tackle-limiting rule implemented in 2014 in a state interscholastic athletic association for all players in grades 9-12. The rule prohibited full contact play during the first practice week, with full contact defined as “drills or game situations that occur at game speed when full tackles are made at a competitive pace and players are taken to the ground.” The players engaged in full contact play for up to 75 minutes total during the second week of practice and then a maximum of 60 min/wk for all subsequent weeks in the practice season. The rule did not apply to games.

For data on the 2 years before the rule change, 2,081 athletes with a mean age of 16 years reported their concussion history in the 2012 season, involving 36 schools, and the 2013 season, involving 18 schools. In 2014, licensed athletic trainers recorded the incidence and severity of each sports-related concussion for the 945 players at 26 schools. Across all three seasons, almost half the concussions (46%) occurred during tackling. Although the overall rate of concussions dropped from 1.57/1,000 athletic exposures in the combined 2012 and 2013 seasons to 1.28/1,000 athletic exposures in the 2014 season, the difference was not significant (P = .155). During the 2012 and 2013 seasons combined, 206 players (9%) sustained 211 concussions, compared with 67 players (7%) with 70 concussions in 2014.

However, the difference in concussions occurring during practice did differ significantly before and after the rule change. The rate of concussions during practice in 2014 was 0.33 concussions per 1,000 athletic exposures, compared with 0.76 concussions per 1,000 exposures in the 2012 and 2013 seasons (P = .003). Twelve of 15 concussions in 2014 practices occurred during full contact practices, a rate of 0.571,000 exposures, and 82 of 86 concussions in the 2012 and 2013 seasons occurred during full contact practices, a rate of 0.87/1,000 exposures (P = .216).

No difference in concussion rate occurred during the games following the rule change: The 2014 rate of concussions during games was 5.74/1,000 exposures, compared with 5.81 in the combined 2012 and 2013 seasons (P = .999). The severity of concussions sustained before and after the rule change also did not differ, and athletes’ years of football-playing experience had no effect on the concussion incidence in 2014.

Despite the relationship between full contact play and concussions, Dr. McGuine said banning tackling from football is not a policy he would support.

“I think the benefits of the sport far outweigh the risks,” Dr. McGuine said. “Concussions particularly have transcended a sports issue and become a public health issue and have become political, and I’m very much against legislators, policy makers, associations making blanket rules without the evidence to back those,” he said. “There are lingering long-term effects from all orthopedic injuries, but we’re focusing on concussions.”

Equipment modification is unlikely to make much difference in concussion rates either, said Dr. McGuine, whose previous study on football helmets found that the brand and model did not influence concussion risk. “Concussions are multifactorial,” he said. “We can’t just limit the amount of force transmitted to the brain and say we’re going to stop these injuries from occurring.”

One important strategy to reducing concussions is increasing parents’ and athletes’ awareness about multiple injuries and ways to reduce the risk, Dr. McGuine said.

“Concussions are like any other injury – ankle sprains, knee injuries and surgeries, shoulder dislocations,” he said. “If you have one, you’re more susceptible to having another one as opposed to somebody who never had that injury, so the problems are repeat injuries and lingering injuries.” Any of these injuries can have a lasting impact on a young athlete’s quality of life, Dr. McGuine added.

Another way to decrease the incidence of concussions is to enforce rules against leading, or lowering, athletes’ heads during tackling.

“A big issue now is penalizing players for leading with their head and face, but I think we need to be consistent there too,” Dr. McGuine said. “We can’t penalize defensive players for lowering their helmet if we’re not going to penalize running backs and wide receivers.”

The research was internally funded. Dr. McGuine reported no relevant financial disclosures.

WASHINGTON – Limiting the amount of full contact tackling that occurs in high school football practice reduced the rate of sports-related concussions that the athletes experienced, a prospective study showed.

“Something as simple as saying they can’t tackle all the time, limiting the amount of minutes each month, reduced the incidence,” Timothy A. McGuine, Ph.D., of the University of Wisconsin, Madison, said at the American Academy of Pediatrics annual meeting.

©Majoros Laszlo/thinkstockphotos.com

“The majority of sports-related concussions sustained in high school football practice occurred during full contact activities,” he said. “The rate of sports-related concussions sustained in high school football practice was more than twice as high in the two seasons prior to a rule change limiting the amount and duration of full contact activities.”

In their study, Dr. McGuine and his associates tested the effects of a tackle-limiting rule implemented in 2014 in a state interscholastic athletic association for all players in grades 9-12. The rule prohibited full contact play during the first practice week, with full contact defined as “drills or game situations that occur at game speed when full tackles are made at a competitive pace and players are taken to the ground.” The players engaged in full contact play for up to 75 minutes total during the second week of practice and then a maximum of 60 min/wk for all subsequent weeks in the practice season. The rule did not apply to games.

For data on the 2 years before the rule change, 2,081 athletes with a mean age of 16 years reported their concussion history in the 2012 season, involving 36 schools, and the 2013 season, involving 18 schools. In 2014, licensed athletic trainers recorded the incidence and severity of each sports-related concussion for the 945 players at 26 schools. Across all three seasons, almost half the concussions (46%) occurred during tackling. Although the overall rate of concussions dropped from 1.57/1,000 athletic exposures in the combined 2012 and 2013 seasons to 1.28/1,000 athletic exposures in the 2014 season, the difference was not significant (P = .155). During the 2012 and 2013 seasons combined, 206 players (9%) sustained 211 concussions, compared with 67 players (7%) with 70 concussions in 2014.

However, the difference in concussions occurring during practice did differ significantly before and after the rule change. The rate of concussions during practice in 2014 was 0.33 concussions per 1,000 athletic exposures, compared with 0.76 concussions per 1,000 exposures in the 2012 and 2013 seasons (P = .003). Twelve of 15 concussions in 2014 practices occurred during full contact practices, a rate of 0.571,000 exposures, and 82 of 86 concussions in the 2012 and 2013 seasons occurred during full contact practices, a rate of 0.87/1,000 exposures (P = .216).

No difference in concussion rate occurred during the games following the rule change: The 2014 rate of concussions during games was 5.74/1,000 exposures, compared with 5.81 in the combined 2012 and 2013 seasons (P = .999). The severity of concussions sustained before and after the rule change also did not differ, and athletes’ years of football-playing experience had no effect on the concussion incidence in 2014.

Despite the relationship between full contact play and concussions, Dr. McGuine said banning tackling from football is not a policy he would support.

“I think the benefits of the sport far outweigh the risks,” Dr. McGuine said. “Concussions particularly have transcended a sports issue and become a public health issue and have become political, and I’m very much against legislators, policy makers, associations making blanket rules without the evidence to back those,” he said. “There are lingering long-term effects from all orthopedic injuries, but we’re focusing on concussions.”

Equipment modification is unlikely to make much difference in concussion rates either, said Dr. McGuine, whose previous study on football helmets found that the brand and model did not influence concussion risk. “Concussions are multifactorial,” he said. “We can’t just limit the amount of force transmitted to the brain and say we’re going to stop these injuries from occurring.”

One important strategy to reducing concussions is increasing parents’ and athletes’ awareness about multiple injuries and ways to reduce the risk, Dr. McGuine said.

“Concussions are like any other injury – ankle sprains, knee injuries and surgeries, shoulder dislocations,” he said. “If you have one, you’re more susceptible to having another one as opposed to somebody who never had that injury, so the problems are repeat injuries and lingering injuries.” Any of these injuries can have a lasting impact on a young athlete’s quality of life, Dr. McGuine added.

Another way to decrease the incidence of concussions is to enforce rules against leading, or lowering, athletes’ heads during tackling.

“A big issue now is penalizing players for leading with their head and face, but I think we need to be consistent there too,” Dr. McGuine said. “We can’t penalize defensive players for lowering their helmet if we’re not going to penalize running backs and wide receivers.”

The research was internally funded. Dr. McGuine reported no relevant financial disclosures.

WASHINGTON – Limiting the amount of full contact tackling that occurs in high school football practice reduced the rate of sports-related concussions that the athletes experienced, a prospective study showed.

“Something as simple as saying they can’t tackle all the time, limiting the amount of minutes each month, reduced the incidence,” Timothy A. McGuine, Ph.D., of the University of Wisconsin, Madison, said at the American Academy of Pediatrics annual meeting.

©Majoros Laszlo/thinkstockphotos.com

“The majority of sports-related concussions sustained in high school football practice occurred during full contact activities,” he said. “The rate of sports-related concussions sustained in high school football practice was more than twice as high in the two seasons prior to a rule change limiting the amount and duration of full contact activities.”

In their study, Dr. McGuine and his associates tested the effects of a tackle-limiting rule implemented in 2014 in a state interscholastic athletic association for all players in grades 9-12. The rule prohibited full contact play during the first practice week, with full contact defined as “drills or game situations that occur at game speed when full tackles are made at a competitive pace and players are taken to the ground.” The players engaged in full contact play for up to 75 minutes total during the second week of practice and then a maximum of 60 min/wk for all subsequent weeks in the practice season. The rule did not apply to games.

For data on the 2 years before the rule change, 2,081 athletes with a mean age of 16 years reported their concussion history in the 2012 season, involving 36 schools, and the 2013 season, involving 18 schools. In 2014, licensed athletic trainers recorded the incidence and severity of each sports-related concussion for the 945 players at 26 schools. Across all three seasons, almost half the concussions (46%) occurred during tackling. Although the overall rate of concussions dropped from 1.57/1,000 athletic exposures in the combined 2012 and 2013 seasons to 1.28/1,000 athletic exposures in the 2014 season, the difference was not significant (P = .155). During the 2012 and 2013 seasons combined, 206 players (9%) sustained 211 concussions, compared with 67 players (7%) with 70 concussions in 2014.

However, the difference in concussions occurring during practice did differ significantly before and after the rule change. The rate of concussions during practice in 2014 was 0.33 concussions per 1,000 athletic exposures, compared with 0.76 concussions per 1,000 exposures in the 2012 and 2013 seasons (P = .003). Twelve of 15 concussions in 2014 practices occurred during full contact practices, a rate of 0.571,000 exposures, and 82 of 86 concussions in the 2012 and 2013 seasons occurred during full contact practices, a rate of 0.87/1,000 exposures (P = .216).

No difference in concussion rate occurred during the games following the rule change: The 2014 rate of concussions during games was 5.74/1,000 exposures, compared with 5.81 in the combined 2012 and 2013 seasons (P = .999). The severity of concussions sustained before and after the rule change also did not differ, and athletes’ years of football-playing experience had no effect on the concussion incidence in 2014.

Despite the relationship between full contact play and concussions, Dr. McGuine said banning tackling from football is not a policy he would support.

“I think the benefits of the sport far outweigh the risks,” Dr. McGuine said. “Concussions particularly have transcended a sports issue and become a public health issue and have become political, and I’m very much against legislators, policy makers, associations making blanket rules without the evidence to back those,” he said. “There are lingering long-term effects from all orthopedic injuries, but we’re focusing on concussions.”

Equipment modification is unlikely to make much difference in concussion rates either, said Dr. McGuine, whose previous study on football helmets found that the brand and model did not influence concussion risk. “Concussions are multifactorial,” he said. “We can’t just limit the amount of force transmitted to the brain and say we’re going to stop these injuries from occurring.”

One important strategy to reducing concussions is increasing parents’ and athletes’ awareness about multiple injuries and ways to reduce the risk, Dr. McGuine said.

“Concussions are like any other injury – ankle sprains, knee injuries and surgeries, shoulder dislocations,” he said. “If you have one, you’re more susceptible to having another one as opposed to somebody who never had that injury, so the problems are repeat injuries and lingering injuries.” Any of these injuries can have a lasting impact on a young athlete’s quality of life, Dr. McGuine added.

Another way to decrease the incidence of concussions is to enforce rules against leading, or lowering, athletes’ heads during tackling.

“A big issue now is penalizing players for leading with their head and face, but I think we need to be consistent there too,” Dr. McGuine said. “We can’t penalize defensive players for lowering their helmet if we’re not going to penalize running backs and wide receivers.”

The research was internally funded. Dr. McGuine reported no relevant financial disclosures.

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Most parents know whether they want to vaccinate their child before the child is even conceived, a study showed.

“Is giving [vaccine] information out at … well-child visits in the pediatrician’s office too late? I think we’re still too early [in our research] to say if that’s the case,” said James N. Yarnall, a fourth-year medical student at the University of North Carolina at Chapel Hill.

The study grew out of talking to parents about their hesitancy toward the hepatitis B vaccine, recommended just after birth, said Mr. Yarnall, whose mentor, pediatrician Jacob Lohr of University of North Carolina Health Care, began asking parents why they were turning down the vaccine.

© javi_indy/ Thinkstock.com

“For a lot of them, they said, ‘We’ve known for a long time,’ ” Mr. Yarnall said.

The two gave surveys to 171 parents (56% of the 304 they asked) who had given birth to a child between February and April 2015 at the University of North Carolina Women’s Hospital in Chapel Hill. The parents answered the question, “When did you develop your preferences for all/certain vaccines for your new baby?”

Among all the parents, 72% said they had developed their vaccination preferences for their newborn before the child had been conceived. The parents reported that friends and family, medical staff, and government agencies such as the Centers for Disease Control and Prevention, played a role in their decisions about vaccines.

Two thirds (66%) of first-time parents reported developing immunization preferences before conception, while 77% of parents with previous children said they had, although the difference was not significant (P = .12). Fathers trended toward being slightly more likely than mothers to have decided their vaccine preferences preconception, but that finding was not significant and weakened further after demographic differences were accounted for.

Parents who had discussed vaccines with one another and who had higher levels of education also were more likely to have decided before conception whether they would vaccinate their newborn. Those who made their vaccine decisions before conception were significantly more likely to plan to vaccinate their children than to decline some or all vaccines (P = .01). Again, this finding was no longer significant following adjustment for demographic covariates.

Although these findings suggest that discussions about vaccines in the pediatrician’s office are coming long past the time when most parents have made up their minds, it’s less clear where to go from here, Mr. Yarnall said.

He and Dr. Lohr are working on a larger study with multiple sites through the Better Outcomes Through Research in Newborns (BORN) network to confirm these findings and determine what the next steps might be.

“We want to make sure the results from this pilot study are reproducible with more national sites,” Mr. Yarnall said. “Once we get those results, we can take it from there.”

WASHINGTON – Pediatricians need to understand the different types of bullying, as well as its risk factors and consequences, according to Dr. Adiaha I.A. Spinks-Franklin, a developmental and behavioral pediatrician at Baylor College of Medicine in Houston.

Knowing how to address bullying and act as a community antibullying advocate is essential as well, Dr. Spinks-Franklin said at the annual meeting of the American Academy of Pediatrics.

Wavebreakmedia/Thinkstock.com

The first step to understanding the problem is understanding the lingo. Bullying is more than making fun of other people. It’s “aggressive behavior that is intentional, repeated over time, and involves an imbalance of power or strength,” Dr. Spinks-Franklin explained. That power imbalance can be physical, social, economic, or involve some power differential. Although the perpetrator is always called the bully, the victim also may be called a “target,” and some children are “bully-victims,” both perpetrators and targets. A third group is the bystanders or witnesses, who also can experience trauma from seeing bullying.

About a third of U.S. children experience bullying, which peaks in middle schools, but that does not mean it’s a normal, acceptable aspect of growing up, Dr. Spinks-Franklin said.

“A lot of teachers think bullying is a normal part of childhood and won’t say anything,” but speaking up can make a difference, Dr. Spinks-Franklin said. “If a child intervenes for another child, the bullying drops. And when an adult intervenes, the effect is even stronger.”

Types of bullying

Most people are familiar with physical bullying – hitting, punching, destruction of physical property or some other physical contact – and verbal bullying such as name-calling or harsh teasing aimed at humiliating the victim. Just as damaging are the other two types of bullying: social or relational bullying and cyberbullying. Boys tend to engage in cyberbullying, verbal bullying, and physical bullying more often than girls, but girls are social bullies more often than are boys.

Social bullying involves excluding someone, spreading rumors about them, or otherwise intentionally interfering with their relationships or their ability to build relationships. Cyberbullying can involve any digital technology, from social media to email to phone texting. With cell phones in the pockets of 75% of teens and an average of 71 texts buzzing those phones each day, according to 2011 and 2015 data, cyberbullying can be deeply intrusive.

Dr. Spinks-Franklin made special mention of a cultural practice called “the Dozens,” or, basically, “trash talk” among African-American children and teens.

“The Dozens is an old tradition of talking smack to your friend. It’s all about verbal comedic talk and coming up with the most incredible insults,” she explained. “There’s timing involved, there’s cadence involved, and you have to maintain emotional regulation or you lose. If you don’t have a good comeback, you lose.”

Examples include classic “Yo Mama” jokes traded back and forth, which she enthusiastically demonstrated to laughter among attendees. But her point was a serious one: If children are shouting insults back and forth and laughing in a group, that’s not verbal bullying. But if a group of children are all taunting a single child who’s not participating or seems distressed, that is verbal bullying.

Consequences of bullying

No one involved is immune to negative effects when bullying is involved, Dr. Spinks-Franklin explained. Victims of bullying have a higher risk of depression, anxiety, poor academic performance, and somatic complaints, particularly on Sunday evenings before they return to school for the week. They also have an increased risk of suicidal thoughts and attempts, which has given rise to the term “bullycide” – a suicide caused by the effects of bullying. On the more extreme end, victims of bullying are at higher risk for violent retaliation, such as attempting or executing mass killings, Dr. Spinks-Franklin said.

Bullies have a different set of risks, starting with a higher risk of alcohol or substance abuse and a greater likelihood to start having sex sooner than peers. Bullies are more likely to get into fights, drop out of school, and vandalize property. As adults, bullies are more likely to rack up traffic citations and criminal convictions and to abuse others, such as romantic partners and children.

Even bystanders who witness bullying suffer, with twice the rate of depression, compared with those who don’t witness bullying. Bystanders also have about a 65% greater odds of anxiety disorders and more than twice the odds of attempting suicide.

Bullying risk factors

Both victims and bullies have identifiable risk factors that are helpful for pediatricians to know about. As individuals, having behavioral problems or depression is a risk factor for being a bully.

“We used to think that bullies had inferior social skills, but some of the newer data tell us that bullies have superior social skills and are so good at manipulating that adults don’t know how they treat people they consider inferior,” Dr. Spinks-Franklin said. “So bullies can have poor social skills or superior social skills.”

Depression and poor social skills also are risk factors for victims, but a major risk factor is simply being an identifiable minority of any kind. A victim’s minority status could relate to religion, sex, race, ethnicity, immigration status, sexual orientation, economic status, hair color, height, or any number of other characteristics. “Whatever it is, you are different from the people around you,” Dr. Spinks-Franklin explained. One study found the three main reasons kids were bullied were their looks, their body shape, and their race.

Risk factors show up in families and environments too. Bullies are more likely to come from families with poor cohesiveness, little warmth, intolerance of different people, physical abuse, authoritarian parenting, and aggression. An absent father is a risk factor for bullies and victims alike. Victims’ mothers are more likely to be controlling, hostile, overprotective, restrictive, threatening, or coddling, and their fathers are more likely to be distant, critical, controlling, uncaring, or neglectful.

Domestic violence, neglect, uninvolved parents, and inconsistent discipline are among the major risk factors for bully-victims. Research also has identified media violence as a risk factor for increased aggression and antisocial behavior. Violent video game players are more likely to become middle-school bullies.

Communities also can be ripe for bullying if they are unsafe, violent, or disorganized. By contrast, safe and connected neighborhoods have a lower risk of bullying among residents. Similarly, classrooms with poor teacher-student relationships and negative peer relationships can be breeding grounds for bullying, as can unsupportive or punitive school environments or ones with misinformed teachers who do not intervene in bullying. Systemic social contributors to bullying include racism, homophobia, sexism, xenophobia, classism, religious intolerance, and ageism.

Addressing bullying

It’s possible to stop bullying, but it requires intentional, evidence-based intervention, particularly throughout entire schools.

“School-wide antibullying curricula on social skills has been found worldwide to greatly reduce bullying and discipline problems in schools,” Dr. Spinks-Franklin explained. Such programs require buy-in from parents and from teachers, who need training and need to intervene consistently and appropriately whenever bullying occurs.

By contrast, zero-tolerance policies are ineffective at preventing or stopping bullying. They may even worsen the problem by discouraging students from reporting bullying. Peer mediation and conflict resolution also send mixed messages to bullies and victims because bullying is an intentional act with an inherent power imbalance, not part of a shared disagreement. Group treatment for bullies also can backfire, leading to worse behaviors from association with other bullies.

Parents can reduce the likelihood that their children will be bullies or victims by using consistent discipline with clear rules and by remaining supportive and fair. If bullying does occur, parents should recognize the warning signs and start a conversation with their children to find out more. Parents can teach and model appropriate behavior and healthy social skills while also working with the school to develop antibullying programs.

Similarly, pediatricians should screen for bullying by asking just three simple questions:

1. Do you ever see kids picking on other kids? (bystander)

2. Do kids ever pick on you? (target/victim)

3. Do you ever pick on other kids? (bully)

Physicians can use the Centers for Disease Control and Prevention’s violence prevention website as a resource and become community advocates against bullies by publicly supporting community-based behavioral health services and raising awareness of bullying among parents, children, teachers, and school administrators. Pediatricians also can push for active local injury surveillance systems in local or state governments and contribute data to existing systems. Finally, pediatricians should familiarize themselves with the resources available to help victims and bullies and to stop or prevent bullying, both online and within their communities.

Dr. Spinks-Franklin said that she had no relevant financial disclosures.

WASHINGTON – Pediatricians need to understand the different types of bullying, as well as its risk factors and consequences, according to Dr. Adiaha I.A. Spinks-Franklin, a developmental and behavioral pediatrician at Baylor College of Medicine in Houston.

Knowing how to address bullying and act as a community antibullying advocate is essential as well, Dr. Spinks-Franklin said at the annual meeting of the American Academy of Pediatrics.

Wavebreakmedia/Thinkstock.com

The first step to understanding the problem is understanding the lingo. Bullying is more than making fun of other people. It’s “aggressive behavior that is intentional, repeated over time, and involves an imbalance of power or strength,” Dr. Spinks-Franklin explained. That power imbalance can be physical, social, economic, or involve some power differential. Although the perpetrator is always called the bully, the victim also may be called a “target,” and some children are “bully-victims,” both perpetrators and targets. A third group is the bystanders or witnesses, who also can experience trauma from seeing bullying.

About a third of U.S. children experience bullying, which peaks in middle schools, but that does not mean it’s a normal, acceptable aspect of growing up, Dr. Spinks-Franklin said.

“A lot of teachers think bullying is a normal part of childhood and won’t say anything,” but speaking up can make a difference, Dr. Spinks-Franklin said. “If a child intervenes for another child, the bullying drops. And when an adult intervenes, the effect is even stronger.”

Types of bullying

Most people are familiar with physical bullying – hitting, punching, destruction of physical property or some other physical contact – and verbal bullying such as name-calling or harsh teasing aimed at humiliating the victim. Just as damaging are the other two types of bullying: social or relational bullying and cyberbullying. Boys tend to engage in cyberbullying, verbal bullying, and physical bullying more often than girls, but girls are social bullies more often than are boys.

Social bullying involves excluding someone, spreading rumors about them, or otherwise intentionally interfering with their relationships or their ability to build relationships. Cyberbullying can involve any digital technology, from social media to email to phone texting. With cell phones in the pockets of 75% of teens and an average of 71 texts buzzing those phones each day, according to 2011 and 2015 data, cyberbullying can be deeply intrusive.

Dr. Spinks-Franklin made special mention of a cultural practice called “the Dozens,” or, basically, “trash talk” among African-American children and teens.

“The Dozens is an old tradition of talking smack to your friend. It’s all about verbal comedic talk and coming up with the most incredible insults,” she explained. “There’s timing involved, there’s cadence involved, and you have to maintain emotional regulation or you lose. If you don’t have a good comeback, you lose.”

Examples include classic “Yo Mama” jokes traded back and forth, which she enthusiastically demonstrated to laughter among attendees. But her point was a serious one: If children are shouting insults back and forth and laughing in a group, that’s not verbal bullying. But if a group of children are all taunting a single child who’s not participating or seems distressed, that is verbal bullying.

Consequences of bullying

No one involved is immune to negative effects when bullying is involved, Dr. Spinks-Franklin explained. Victims of bullying have a higher risk of depression, anxiety, poor academic performance, and somatic complaints, particularly on Sunday evenings before they return to school for the week. They also have an increased risk of suicidal thoughts and attempts, which has given rise to the term “bullycide” – a suicide caused by the effects of bullying. On the more extreme end, victims of bullying are at higher risk for violent retaliation, such as attempting or executing mass killings, Dr. Spinks-Franklin said.

Bullies have a different set of risks, starting with a higher risk of alcohol or substance abuse and a greater likelihood to start having sex sooner than peers. Bullies are more likely to get into fights, drop out of school, and vandalize property. As adults, bullies are more likely to rack up traffic citations and criminal convictions and to abuse others, such as romantic partners and children.

Even bystanders who witness bullying suffer, with twice the rate of depression, compared with those who don’t witness bullying. Bystanders also have about a 65% greater odds of anxiety disorders and more than twice the odds of attempting suicide.

Bullying risk factors

Both victims and bullies have identifiable risk factors that are helpful for pediatricians to know about. As individuals, having behavioral problems or depression is a risk factor for being a bully.

“We used to think that bullies had inferior social skills, but some of the newer data tell us that bullies have superior social skills and are so good at manipulating that adults don’t know how they treat people they consider inferior,” Dr. Spinks-Franklin said. “So bullies can have poor social skills or superior social skills.”

Depression and poor social skills also are risk factors for victims, but a major risk factor is simply being an identifiable minority of any kind. A victim’s minority status could relate to religion, sex, race, ethnicity, immigration status, sexual orientation, economic status, hair color, height, or any number of other characteristics. “Whatever it is, you are different from the people around you,” Dr. Spinks-Franklin explained. One study found the three main reasons kids were bullied were their looks, their body shape, and their race.

Risk factors show up in families and environments too. Bullies are more likely to come from families with poor cohesiveness, little warmth, intolerance of different people, physical abuse, authoritarian parenting, and aggression. An absent father is a risk factor for bullies and victims alike. Victims’ mothers are more likely to be controlling, hostile, overprotective, restrictive, threatening, or coddling, and their fathers are more likely to be distant, critical, controlling, uncaring, or neglectful.

Domestic violence, neglect, uninvolved parents, and inconsistent discipline are among the major risk factors for bully-victims. Research also has identified media violence as a risk factor for increased aggression and antisocial behavior. Violent video game players are more likely to become middle-school bullies.

Communities also can be ripe for bullying if they are unsafe, violent, or disorganized. By contrast, safe and connected neighborhoods have a lower risk of bullying among residents. Similarly, classrooms with poor teacher-student relationships and negative peer relationships can be breeding grounds for bullying, as can unsupportive or punitive school environments or ones with misinformed teachers who do not intervene in bullying. Systemic social contributors to bullying include racism, homophobia, sexism, xenophobia, classism, religious intolerance, and ageism.

Addressing bullying

It’s possible to stop bullying, but it requires intentional, evidence-based intervention, particularly throughout entire schools.

“School-wide antibullying curricula on social skills has been found worldwide to greatly reduce bullying and discipline problems in schools,” Dr. Spinks-Franklin explained. Such programs require buy-in from parents and from teachers, who need training and need to intervene consistently and appropriately whenever bullying occurs.

By contrast, zero-tolerance policies are ineffective at preventing or stopping bullying. They may even worsen the problem by discouraging students from reporting bullying. Peer mediation and conflict resolution also send mixed messages to bullies and victims because bullying is an intentional act with an inherent power imbalance, not part of a shared disagreement. Group treatment for bullies also can backfire, leading to worse behaviors from association with other bullies.

Parents can reduce the likelihood that their children will be bullies or victims by using consistent discipline with clear rules and by remaining supportive and fair. If bullying does occur, parents should recognize the warning signs and start a conversation with their children to find out more. Parents can teach and model appropriate behavior and healthy social skills while also working with the school to develop antibullying programs.

Similarly, pediatricians should screen for bullying by asking just three simple questions:

1. Do you ever see kids picking on other kids? (bystander)

2. Do kids ever pick on you? (target/victim)

3. Do you ever pick on other kids? (bully)

Physicians can use the Centers for Disease Control and Prevention’s violence prevention website as a resource and become community advocates against bullies by publicly supporting community-based behavioral health services and raising awareness of bullying among parents, children, teachers, and school administrators. Pediatricians also can push for active local injury surveillance systems in local or state governments and contribute data to existing systems. Finally, pediatricians should familiarize themselves with the resources available to help victims and bullies and to stop or prevent bullying, both online and within their communities.

Dr. Spinks-Franklin said that she had no relevant financial disclosures.

WASHINGTON – Pediatricians need to understand the different types of bullying, as well as its risk factors and consequences, according to Dr. Adiaha I.A. Spinks-Franklin, a developmental and behavioral pediatrician at Baylor College of Medicine in Houston.

Knowing how to address bullying and act as a community antibullying advocate is essential as well, Dr. Spinks-Franklin said at the annual meeting of the American Academy of Pediatrics.

Wavebreakmedia/Thinkstock.com

The first step to understanding the problem is understanding the lingo. Bullying is more than making fun of other people. It’s “aggressive behavior that is intentional, repeated over time, and involves an imbalance of power or strength,” Dr. Spinks-Franklin explained. That power imbalance can be physical, social, economic, or involve some power differential. Although the perpetrator is always called the bully, the victim also may be called a “target,” and some children are “bully-victims,” both perpetrators and targets. A third group is the bystanders or witnesses, who also can experience trauma from seeing bullying.

About a third of U.S. children experience bullying, which peaks in middle schools, but that does not mean it’s a normal, acceptable aspect of growing up, Dr. Spinks-Franklin said.

“A lot of teachers think bullying is a normal part of childhood and won’t say anything,” but speaking up can make a difference, Dr. Spinks-Franklin said. “If a child intervenes for another child, the bullying drops. And when an adult intervenes, the effect is even stronger.”

Types of bullying

Most people are familiar with physical bullying – hitting, punching, destruction of physical property or some other physical contact – and verbal bullying such as name-calling or harsh teasing aimed at humiliating the victim. Just as damaging are the other two types of bullying: social or relational bullying and cyberbullying. Boys tend to engage in cyberbullying, verbal bullying, and physical bullying more often than girls, but girls are social bullies more often than are boys.

Social bullying involves excluding someone, spreading rumors about them, or otherwise intentionally interfering with their relationships or their ability to build relationships. Cyberbullying can involve any digital technology, from social media to email to phone texting. With cell phones in the pockets of 75% of teens and an average of 71 texts buzzing those phones each day, according to 2011 and 2015 data, cyberbullying can be deeply intrusive.

Dr. Spinks-Franklin made special mention of a cultural practice called “the Dozens,” or, basically, “trash talk” among African-American children and teens.

“The Dozens is an old tradition of talking smack to your friend. It’s all about verbal comedic talk and coming up with the most incredible insults,” she explained. “There’s timing involved, there’s cadence involved, and you have to maintain emotional regulation or you lose. If you don’t have a good comeback, you lose.”

Examples include classic “Yo Mama” jokes traded back and forth, which she enthusiastically demonstrated to laughter among attendees. But her point was a serious one: If children are shouting insults back and forth and laughing in a group, that’s not verbal bullying. But if a group of children are all taunting a single child who’s not participating or seems distressed, that is verbal bullying.

Consequences of bullying

No one involved is immune to negative effects when bullying is involved, Dr. Spinks-Franklin explained. Victims of bullying have a higher risk of depression, anxiety, poor academic performance, and somatic complaints, particularly on Sunday evenings before they return to school for the week. They also have an increased risk of suicidal thoughts and attempts, which has given rise to the term “bullycide” – a suicide caused by the effects of bullying. On the more extreme end, victims of bullying are at higher risk for violent retaliation, such as attempting or executing mass killings, Dr. Spinks-Franklin said.

Bullies have a different set of risks, starting with a higher risk of alcohol or substance abuse and a greater likelihood to start having sex sooner than peers. Bullies are more likely to get into fights, drop out of school, and vandalize property. As adults, bullies are more likely to rack up traffic citations and criminal convictions and to abuse others, such as romantic partners and children.

Even bystanders who witness bullying suffer, with twice the rate of depression, compared with those who don’t witness bullying. Bystanders also have about a 65% greater odds of anxiety disorders and more than twice the odds of attempting suicide.

Bullying risk factors

Both victims and bullies have identifiable risk factors that are helpful for pediatricians to know about. As individuals, having behavioral problems or depression is a risk factor for being a bully.

“We used to think that bullies had inferior social skills, but some of the newer data tell us that bullies have superior social skills and are so good at manipulating that adults don’t know how they treat people they consider inferior,” Dr. Spinks-Franklin said. “So bullies can have poor social skills or superior social skills.”

Depression and poor social skills also are risk factors for victims, but a major risk factor is simply being an identifiable minority of any kind. A victim’s minority status could relate to religion, sex, race, ethnicity, immigration status, sexual orientation, economic status, hair color, height, or any number of other characteristics. “Whatever it is, you are different from the people around you,” Dr. Spinks-Franklin explained. One study found the three main reasons kids were bullied were their looks, their body shape, and their race.

Risk factors show up in families and environments too. Bullies are more likely to come from families with poor cohesiveness, little warmth, intolerance of different people, physical abuse, authoritarian parenting, and aggression. An absent father is a risk factor for bullies and victims alike. Victims’ mothers are more likely to be controlling, hostile, overprotective, restrictive, threatening, or coddling, and their fathers are more likely to be distant, critical, controlling, uncaring, or neglectful.

Domestic violence, neglect, uninvolved parents, and inconsistent discipline are among the major risk factors for bully-victims. Research also has identified media violence as a risk factor for increased aggression and antisocial behavior. Violent video game players are more likely to become middle-school bullies.

Communities also can be ripe for bullying if they are unsafe, violent, or disorganized. By contrast, safe and connected neighborhoods have a lower risk of bullying among residents. Similarly, classrooms with poor teacher-student relationships and negative peer relationships can be breeding grounds for bullying, as can unsupportive or punitive school environments or ones with misinformed teachers who do not intervene in bullying. Systemic social contributors to bullying include racism, homophobia, sexism, xenophobia, classism, religious intolerance, and ageism.

Addressing bullying

It’s possible to stop bullying, but it requires intentional, evidence-based intervention, particularly throughout entire schools.

“School-wide antibullying curricula on social skills has been found worldwide to greatly reduce bullying and discipline problems in schools,” Dr. Spinks-Franklin explained. Such programs require buy-in from parents and from teachers, who need training and need to intervene consistently and appropriately whenever bullying occurs.

By contrast, zero-tolerance policies are ineffective at preventing or stopping bullying. They may even worsen the problem by discouraging students from reporting bullying. Peer mediation and conflict resolution also send mixed messages to bullies and victims because bullying is an intentional act with an inherent power imbalance, not part of a shared disagreement. Group treatment for bullies also can backfire, leading to worse behaviors from association with other bullies.

Parents can reduce the likelihood that their children will be bullies or victims by using consistent discipline with clear rules and by remaining supportive and fair. If bullying does occur, parents should recognize the warning signs and start a conversation with their children to find out more. Parents can teach and model appropriate behavior and healthy social skills while also working with the school to develop antibullying programs.

Similarly, pediatricians should screen for bullying by asking just three simple questions:

1. Do you ever see kids picking on other kids? (bystander)

2. Do kids ever pick on you? (target/victim)

3. Do you ever pick on other kids? (bully)

Physicians can use the Centers for Disease Control and Prevention’s violence prevention website as a resource and become community advocates against bullies by publicly supporting community-based behavioral health services and raising awareness of bullying among parents, children, teachers, and school administrators. Pediatricians also can push for active local injury surveillance systems in local or state governments and contribute data to existing systems. Finally, pediatricians should familiarize themselves with the resources available to help victims and bullies and to stop or prevent bullying, both online and within their communities.

Dr. Spinks-Franklin said that she had no relevant financial disclosures.

The two president-elect candidates for the American Academy of Pediatrics spoke Saturday about what they would do for the organization and how they would advocate for governmental policies benefiting children and pediatricians, during the first official day of the organization’s annual meeting in Washington.

AAP members can vote for Dr. Fernando Stein, FAAP, of Houston, or Dr. Lynda M. Young, FAAP, of Worcester, Mass., during the voting period from Oct. 23 through Nov. 24.

Dr. Stein spoke first, calling to mind the first meeting of pediatricians in 1929 that eventually led to the formation of the AAP and how different children’s needs and the demands on pediatricians are today.

“Our world has changed, pediatrics has changed, the needs of children have changed, our needs as pediatricians have changed, and if we are to be relevant to our mission, we as individuals and as fellows of the academy must change,” he said.

But Dr. Stein pointed out that pediatricians must now do more and more with less and less support from health systems each day, a status quo that is taking a toll on doctors.

“We chose our profession by our natural altruistic inclinations, and currently by self-report, more than 50% of us are burnt out, empathy exhausted, and compassion fatigued,” Dr. Stein said. “I believe that now is the time for the Academy to take a loud and clear and unmistakable position in defense of the pediatrician. It is no longer sufficient to prioritize children when the pediatrician is hurting,” he said to applause.

One challenge Dr. Stein said he would tackle is the process of maintaining certification, a system that he gleaned from local chapters “is thought to be more of an intermittent threat rather than a lifelong commitment to learning,” a description that provoked laughter and applause.

“We need to remove this as a toxic stress to the pediatrician,” he said, eliciting more laughter as he alluded to the previous day’s presentations on the toxic stress children experience. He pledged to ensure the Academy would amend current requirements for certification and maintenance of certification and to address the cost for both.

Dr. Stein also called for the Academy to build a technology platform for sharing data among members and mentioned his work as chairman of the Council on Sections and the Committee on Membership as helpful to this goal.

The most enthusiastically received message Dr. Stein delivered, however, related to the toll of gun violence in the United States. He cited injuries from all causes, suicide, and homicides as the first, third and fourth leading causes of death of youth aged 5-21 years, ranked above respiratory diseases, infections, and sepsis.

“The gun violence issue is by any definition an epidemic and a public health problem,” he said to applause. “The oversimplification of violence as a problem of social justice is unjustified.”

He noted that any other bacterial, viral, or other agent of infection that killed close to 100 people and injured hundreds more every day would unquestionably be called a public health problem demanding scientific research.

“As president of the AAP, I pledge to challenge the legislative efforts aimed at inhibiting pediatricians and scientific organizations from gathering potentially lifesaving information about firearms just as we did in the past with vaccines,” he said. “Is it not time to approach this with the same vigor of scientific inquiry we undertook for the prevention of communicable diseases?”

Next, Dr. Young opened and closed with the question “What do children need?” and spent her talk describing ways in which the answer is pediatricians themselves, remaining at the forefront of addressing the toxic challenges children face.

“Some days in our offices and our clinics, we’re not just physicians,” she said. “We’re nurses, we’re social workers, we’re pharmacists, we’re health insurance advisers, we’re nutritionists, we’re accountants, we’re teachers – all in the interest of trying to change for the better what children see and hear.”

She praised the advocacy efforts of many pediatricians in the room and described advocacy as a team sport to ensure children have access to care and appropriate essential health benefits, particularly if – and maybe when – children’s health insurance becomes part of health insurance exchanges instead of the Children’s Health Insurance Programs (CHIP).

“I spent a fair amount of time talking to legislators to prioritize children’s needs,” Dr. Young said. “I want funding to continue. No, I want funding to increase significantly for the programs that have proof of effectiveness for kids,” she continued to applause. She mentioned programs such as Women, Infants, and Children (WIC), early intervention and home visits for mothers and children.

“We need federal policy to address practice transformation: e-cigarette regulation, opioid abuse, vaccine refusal, gun control, drug pricing, graduate medical education reform,” Dr. Young said. “There are so many issues.”

She noted past legislative wins, including the Affordable Care Act – which garnered applause – for providing access to care and insurance to more people than ever before, and the CHIP Reauthorization Act, extending CHIP funding through 2017.

After describing challenges she’s heard pediatricians are facing in their practices, Dr. Young said some could become opportunities.

“For us to succeed in meeting children’s needs, we need to address our own concerns,” she said. “We need to ensure that we, primary care, specialty, subspecialty, whether you’re in a small independent practice or a large integrated system, have the resources and information to continue to provide the care for our most vulnerable population.”

Dr. Young suggested that offering virtual visits and partnering with telemedicine companies to maintain patients’ continuity of care might comprise one such opportunity, particularly if these services require payment to increase revenue since pediatricians have been providing after-hours care for free for years. She also suggested partnering with retail-based clinics, providing clinical knowledge and knowledge of the community.

“On the federal level, the Academy needs to remain a strong voice and continue to collaborate with other organized medical associations,” Dr. Young continued. “The Centers for Medicare & Medicaid respond to physician concerns, especially when presented by a unified front of physicians working together.”

She exhorted pediatricians never to forget how important they are to the children and families they care for.

“What do children need? They need us,” Dr. Young said to applause. “We pediatricians have a reputation for fairness, and we focus on the right priorities. Our children need us.”

The two president-elect candidates for the American Academy of Pediatrics spoke Saturday about what they would do for the organization and how they would advocate for governmental policies benefiting children and pediatricians, during the first official day of the organization’s annual meeting in Washington.

AAP members can vote for Dr. Fernando Stein, FAAP, of Houston, or Dr. Lynda M. Young, FAAP, of Worcester, Mass., during the voting period from Oct. 23 through Nov. 24.

Dr. Stein spoke first, calling to mind the first meeting of pediatricians in 1929 that eventually led to the formation of the AAP and how different children’s needs and the demands on pediatricians are today.

“Our world has changed, pediatrics has changed, the needs of children have changed, our needs as pediatricians have changed, and if we are to be relevant to our mission, we as individuals and as fellows of the academy must change,” he said.

But Dr. Stein pointed out that pediatricians must now do more and more with less and less support from health systems each day, a status quo that is taking a toll on doctors.

“We chose our profession by our natural altruistic inclinations, and currently by self-report, more than 50% of us are burnt out, empathy exhausted, and compassion fatigued,” Dr. Stein said. “I believe that now is the time for the Academy to take a loud and clear and unmistakable position in defense of the pediatrician. It is no longer sufficient to prioritize children when the pediatrician is hurting,” he said to applause.

One challenge Dr. Stein said he would tackle is the process of maintaining certification, a system that he gleaned from local chapters “is thought to be more of an intermittent threat rather than a lifelong commitment to learning,” a description that provoked laughter and applause.

“We need to remove this as a toxic stress to the pediatrician,” he said, eliciting more laughter as he alluded to the previous day’s presentations on the toxic stress children experience. He pledged to ensure the Academy would amend current requirements for certification and maintenance of certification and to address the cost for both.

Dr. Stein also called for the Academy to build a technology platform for sharing data among members and mentioned his work as chairman of the Council on Sections and the Committee on Membership as helpful to this goal.

The most enthusiastically received message Dr. Stein delivered, however, related to the toll of gun violence in the United States. He cited injuries from all causes, suicide, and homicides as the first, third and fourth leading causes of death of youth aged 5-21 years, ranked above respiratory diseases, infections, and sepsis.

“The gun violence issue is by any definition an epidemic and a public health problem,” he said to applause. “The oversimplification of violence as a problem of social justice is unjustified.”

He noted that any other bacterial, viral, or other agent of infection that killed close to 100 people and injured hundreds more every day would unquestionably be called a public health problem demanding scientific research.

“As president of the AAP, I pledge to challenge the legislative efforts aimed at inhibiting pediatricians and scientific organizations from gathering potentially lifesaving information about firearms just as we did in the past with vaccines,” he said. “Is it not time to approach this with the same vigor of scientific inquiry we undertook for the prevention of communicable diseases?”

Next, Dr. Young opened and closed with the question “What do children need?” and spent her talk describing ways in which the answer is pediatricians themselves, remaining at the forefront of addressing the toxic challenges children face.

“Some days in our offices and our clinics, we’re not just physicians,” she said. “We’re nurses, we’re social workers, we’re pharmacists, we’re health insurance advisers, we’re nutritionists, we’re accountants, we’re teachers – all in the interest of trying to change for the better what children see and hear.”

She praised the advocacy efforts of many pediatricians in the room and described advocacy as a team sport to ensure children have access to care and appropriate essential health benefits, particularly if – and maybe when – children’s health insurance becomes part of health insurance exchanges instead of the Children’s Health Insurance Programs (CHIP).

“I spent a fair amount of time talking to legislators to prioritize children’s needs,” Dr. Young said. “I want funding to continue. No, I want funding to increase significantly for the programs that have proof of effectiveness for kids,” she continued to applause. She mentioned programs such as Women, Infants, and Children (WIC), early intervention and home visits for mothers and children.

“We need federal policy to address practice transformation: e-cigarette regulation, opioid abuse, vaccine refusal, gun control, drug pricing, graduate medical education reform,” Dr. Young said. “There are so many issues.”

She noted past legislative wins, including the Affordable Care Act – which garnered applause – for providing access to care and insurance to more people than ever before, and the CHIP Reauthorization Act, extending CHIP funding through 2017.

After describing challenges she’s heard pediatricians are facing in their practices, Dr. Young said some could become opportunities.

“For us to succeed in meeting children’s needs, we need to address our own concerns,” she said. “We need to ensure that we, primary care, specialty, subspecialty, whether you’re in a small independent practice or a large integrated system, have the resources and information to continue to provide the care for our most vulnerable population.”

Dr. Young suggested that offering virtual visits and partnering with telemedicine companies to maintain patients’ continuity of care might comprise one such opportunity, particularly if these services require payment to increase revenue since pediatricians have been providing after-hours care for free for years. She also suggested partnering with retail-based clinics, providing clinical knowledge and knowledge of the community.

“On the federal level, the Academy needs to remain a strong voice and continue to collaborate with other organized medical associations,” Dr. Young continued. “The Centers for Medicare & Medicaid respond to physician concerns, especially when presented by a unified front of physicians working together.”

She exhorted pediatricians never to forget how important they are to the children and families they care for.

“What do children need? They need us,” Dr. Young said to applause. “We pediatricians have a reputation for fairness, and we focus on the right priorities. Our children need us.”

The two president-elect candidates for the American Academy of Pediatrics spoke Saturday about what they would do for the organization and how they would advocate for governmental policies benefiting children and pediatricians, during the first official day of the organization’s annual meeting in Washington.

AAP members can vote for Dr. Fernando Stein, FAAP, of Houston, or Dr. Lynda M. Young, FAAP, of Worcester, Mass., during the voting period from Oct. 23 through Nov. 24.

Dr. Stein spoke first, calling to mind the first meeting of pediatricians in 1929 that eventually led to the formation of the AAP and how different children’s needs and the demands on pediatricians are today.

“Our world has changed, pediatrics has changed, the needs of children have changed, our needs as pediatricians have changed, and if we are to be relevant to our mission, we as individuals and as fellows of the academy must change,” he said.

But Dr. Stein pointed out that pediatricians must now do more and more with less and less support from health systems each day, a status quo that is taking a toll on doctors.

“We chose our profession by our natural altruistic inclinations, and currently by self-report, more than 50% of us are burnt out, empathy exhausted, and compassion fatigued,” Dr. Stein said. “I believe that now is the time for the Academy to take a loud and clear and unmistakable position in defense of the pediatrician. It is no longer sufficient to prioritize children when the pediatrician is hurting,” he said to applause.

One challenge Dr. Stein said he would tackle is the process of maintaining certification, a system that he gleaned from local chapters “is thought to be more of an intermittent threat rather than a lifelong commitment to learning,” a description that provoked laughter and applause.

“We need to remove this as a toxic stress to the pediatrician,” he said, eliciting more laughter as he alluded to the previous day’s presentations on the toxic stress children experience. He pledged to ensure the Academy would amend current requirements for certification and maintenance of certification and to address the cost for both.

Dr. Stein also called for the Academy to build a technology platform for sharing data among members and mentioned his work as chairman of the Council on Sections and the Committee on Membership as helpful to this goal.

The most enthusiastically received message Dr. Stein delivered, however, related to the toll of gun violence in the United States. He cited injuries from all causes, suicide, and homicides as the first, third and fourth leading causes of death of youth aged 5-21 years, ranked above respiratory diseases, infections, and sepsis.

“The gun violence issue is by any definition an epidemic and a public health problem,” he said to applause. “The oversimplification of violence as a problem of social justice is unjustified.”

He noted that any other bacterial, viral, or other agent of infection that killed close to 100 people and injured hundreds more every day would unquestionably be called a public health problem demanding scientific research.

“As president of the AAP, I pledge to challenge the legislative efforts aimed at inhibiting pediatricians and scientific organizations from gathering potentially lifesaving information about firearms just as we did in the past with vaccines,” he said. “Is it not time to approach this with the same vigor of scientific inquiry we undertook for the prevention of communicable diseases?”

Next, Dr. Young opened and closed with the question “What do children need?” and spent her talk describing ways in which the answer is pediatricians themselves, remaining at the forefront of addressing the toxic challenges children face.

“Some days in our offices and our clinics, we’re not just physicians,” she said. “We’re nurses, we’re social workers, we’re pharmacists, we’re health insurance advisers, we’re nutritionists, we’re accountants, we’re teachers – all in the interest of trying to change for the better what children see and hear.”

She praised the advocacy efforts of many pediatricians in the room and described advocacy as a team sport to ensure children have access to care and appropriate essential health benefits, particularly if – and maybe when – children’s health insurance becomes part of health insurance exchanges instead of the Children’s Health Insurance Programs (CHIP).

“I spent a fair amount of time talking to legislators to prioritize children’s needs,” Dr. Young said. “I want funding to continue. No, I want funding to increase significantly for the programs that have proof of effectiveness for kids,” she continued to applause. She mentioned programs such as Women, Infants, and Children (WIC), early intervention and home visits for mothers and children.

“We need federal policy to address practice transformation: e-cigarette regulation, opioid abuse, vaccine refusal, gun control, drug pricing, graduate medical education reform,” Dr. Young said. “There are so many issues.”

She noted past legislative wins, including the Affordable Care Act – which garnered applause – for providing access to care and insurance to more people than ever before, and the CHIP Reauthorization Act, extending CHIP funding through 2017.

After describing challenges she’s heard pediatricians are facing in their practices, Dr. Young said some could become opportunities.

“For us to succeed in meeting children’s needs, we need to address our own concerns,” she said. “We need to ensure that we, primary care, specialty, subspecialty, whether you’re in a small independent practice or a large integrated system, have the resources and information to continue to provide the care for our most vulnerable population.”

Dr. Young suggested that offering virtual visits and partnering with telemedicine companies to maintain patients’ continuity of care might comprise one such opportunity, particularly if these services require payment to increase revenue since pediatricians have been providing after-hours care for free for years. She also suggested partnering with retail-based clinics, providing clinical knowledge and knowledge of the community.

“On the federal level, the Academy needs to remain a strong voice and continue to collaborate with other organized medical associations,” Dr. Young continued. “The Centers for Medicare & Medicaid respond to physician concerns, especially when presented by a unified front of physicians working together.”

She exhorted pediatricians never to forget how important they are to the children and families they care for.

“What do children need? They need us,” Dr. Young said to applause. “We pediatricians have a reputation for fairness, and we focus on the right priorities. Our children need us.”