American Academy of Pediatrics reviews toddler ‘formulas,’ questions marketing of drinks

A growing array of drinks advertised as a nutritious next step following human milk or infant formula lack standard composition and nutrition requirements

Peer-Reviewed Publication

AMERICAN ACADEMY OF PEDIATRICS

 

Toddler “formulas” that are promoted as nutritious drinks for the older infant or preschooler are generally unnecessary and nutritionally incomplete, and the marketing practices that promote them are questionable, according to the American Academy of Pediatrics. 

The AAP has published a new clinical report, “Older Infant-Young Child ‘Formulas,’ ” that reviews the growing array of drinks aimed at children ages 6-36 months and observes that they lack standardization or regulatory oversight. The clinical report, developed by the AAP Committee on Nutrition, will be released on Friday, Oct. 20, during the 2023 AAP Conference & Exhibition in Washington, D.C. The authors will discuss the clinical report during a session, “Toddler Formula, Growing Up Milk, Transition Formula: What’s in a Name?” from 2:30-3:30 p.m. Friday at the Walter E. Washington Convention Center, 146C. 

The session will be repeated from 7:30 a.m.-8:30 a.m. Saturday, Oct. 21, at the convention center, Room 207A. 

The authors will be available for interviews. Contact AAP Public Affairs to request an interview. 

“Products that are advertised as ‘follow-up formulas,’ ‘weaning formulas,’ or ‘toddler milks and formulas,’ are misleadingly promoted as a necessary part of a healthy child’s diet or, for those directed at young infants, equivalent to infant formula,”  said lead author George J. Fuchs, III, MD, FAAP, a member of the Committee on Nutrition, which produced the clinical report.   

“These drinks should not replace a balanced diet and are inferior to standard infant formula in children less than 12 months of age and offer no benefit over much less expensive cow’s milk in most children older than age 12 months. Some children may have special nutritional needs, as well, and so as with any child, it is always best to check with your pediatrician.” 

The clinical report will be published in the November 2023 Pediatrics (published online Oct. 20). Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. 

The AAP supports continued breastfeeding along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. If the infant is not breastfed, the AAP and others recommend whole cow milk as suitable for infants beginning at 12 months of age as part of a nutritionally complete, balanced diet. 

Although medical or therapeutic formulas are indicated for a variety of conditions, such as chronic gastrointestinal diseases, metabolic disorders, food allergy, and others, such prescribed formulas are different from older infant-young child “formulas”.  

“It’s understandable that families and caregivers may be confused by the different names, compositions, and purported benefits of these so-called ‘formulas,’ ” said Steven A. Abrams, MD, FAAP, co-author of the report. “Some of the toddler drinks are high in sugar.  And to top it off, they are typically more expensive than cow’s milk.” 

As of now, the U.S. has no regulatory oversight to ensure that formulas for this age group adhere to any set of uniform standards. 

The AAP recommends: 

• For infants younger than 12 months, the liquid portion of the diet should be provided by human milk or standard infant formula, which in the U.S. have been reviewed by the U.S. Food and Drug Administration based on the Infant Formula Act. 

• For toddlers (children 12 months and older), caregivers should provide a varied diet with fortified foods to optimize nutritional intake. Older infant-young child “formulas” can safely be used as part of a varied diet for children but do not provide a nutritional advantage in most children over a well-balanced diet that includes human milk or cow milk.  

• Marketing of these drinks should make a clear and unambiguous distinction from standard infant formula in promotional materials, logos, product names, and packaging. They should not be placed alongside infant formula on store shelves. 

• Pediatricians should complete a focused nutritional assessment of children and offer adjustment of solid food intake or vitamin supplementation as needed.  

 

“We are all familiar with picky eaters. And there may be reasons why some families avoid cow’s milk and dairy products,” Dr. Fuchs said. “That’s why it’s important to ask your pediatrician to evaluate if children are getting all the nutrients they need. Together, you can discuss a plan to address any potential deficiencies.” 

To request an embargoed copy of the clinical report or an interview with an author, contact AAP Public Affairs. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists whose mission is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.  

For frequent updates on AAP recommendations, Pediatrics studies, AAP in the news, public awareness campaigns, information for parents and more, follow us on social media @AmerAcadPeds.  

 

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METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

American Academy of Pediatrics Reviews Toddler ‘Formulas,’ Questions Marketing of Drinks

ARTICLE PUBLICATION DATE

20-Oct-2023

 

Electric hair styling products common cause of burn injuries in children

Roughly 31,000 hairstyling product-related injuries in children between 2013-22; curling irons and curlers most likely hair styling products to require hospital visit for children

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— Electronic hair styling products like curling irons are a common cause of burn injuries around the home, particularly among young children, resulting in almost 31,000 burns in children and young people between 2013-22, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.  

Researchers who wrote the abstract, “Burn Injuries in Children from Hair Styling Tools Presenting to United States Emergency Departments, 2013-2022: Beauty is More Than Skin Deep,” studied data on emergency department visits involving hair styling equipment for patients ages 24 and younger from the National Electronic Injury Surveillance System database. Research showed that from 2013 to 2022 there were an estimated 30,839 burn injuries from hair styling tools and 1,050 emergency department visits. Hair curlers and curling irons accounted for 97.4% of the burn injuries reported. 

“Hair styling tools are a timeless piece of our everyday routine, helping to create the picture-perfect look. Yet they have the greatest propensity to create a not so picture-perfect accident when not handled with care,” said CPT Brandon L. Rozanski, MD, lead author and pediatric resident at Tripler Army Medical Center. “Electric hair styling tools can reach temperatures as high as 450ºF in a matter of minutes, creating potential situations of unintentional burn injury for both the device user and surrounding bystanders.” 

Of those hospital emergency department encounters studied, 68% of the injured subjects were age 10 or younger and 65.1% were female. Almost three quarters of these injuries occurred within the home (72.3%), and 98.6% did not require hospital stays or require any other escalation of care. 

“This study demonstrated that children have the greatest propensity to present to the emergency department with burn injuries sustained from hair styling tools,” CPT Rozanski said. “Using this information, clinicians have a unique opportunity to provide targeted anticipatory guidance to educate families on the hazard surrounding everyday use of electric hair styling tools in addition to stressing age-appropriate use with and without parental supervision.” 

The research authors did not receive financial support for this research. 

CPT Rozanski is scheduled to present his research, which is below, from 4:45-5:45 PM Sunday, Oct. 22, in Exhibit Hall A at the Walter E. Washington Convention Center. To request an interview with the authors, contact CPT CPT Rozanski, MD, at rozanskib97@gmail.com. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

# # #

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Program Name: AAP National Conference & Exhibition

Submission Type: Section on Uniformed Services

Abstract Title: Burn Injuries in Children from Hair Styling Tools Presenting to United States Emergency Departments, 2013-2022: Beauty is More Than Skin Deep

Brandon Rozanski 

Severn, MD, United States 

Electric hair styling tools are common household items, often employed for daily use by people of varying ages and gender. With temperatures reaching as high as 450ºF in a matter of minutes, hair styling tools have the potential to result in an unintentional burn injury for both the device user and surrounding bystanders. Prior studies investigating hair styling tool-related injuries have focused primarily on one electronic device – the curling iron – and have limited analyses on the mechanism of injury. The frequency of burn injuries from hair styling tools across the product spectrum is not well-defined. The purpose of our study is to address the literature gap and better characterize the epidemiology of burn injuries from hair styling tools that present to emergency departments (ED) in the United States from 2013-2022. 

The National Electronic Injury Surveillance System (NEISS) database was queried using the hair styling tool-related product codes (1682-hair curlers and curling irons, 1602-hair dryers, 1662-hair grooming equipment and accessories, 1651- combs not specified, and 1637- electric combs) for ED visits in the United States. We evaluated the frequency of injuries in subjects ages 0-24 years from 2013-2022 whose injuries involved the aforementioned products, and the subject was diagnosed with a burn (diagnosis codes= 46-49 and 51). All reported values are population national estimates generated from actual hair styling tool-related injury encounters. These were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons. 

From 2013 to 2022, there were an estimated 30,839 (95% confidence interval (CI) 24,761 – 36,918) burn injuries from hair styling tools generated from 1,050 actual emergency department encounters captured (Table 1).

Approximately 68% of the injured subjects were younger than 10 years of age (median age 4.3 years, interquartile range (IQR) 2.0-15.2 years). Persons were more likely to be female (65.1%). The majority of these injuries occurred within the home (72.3%). Of the burn injuries from hair styling tools, 98.6% had no escalation of care required. For the hair styling tool consumer products analyzed, the product code 1682—Hair Curlers, Curling Irons—accounted for 97.4% of the burn injuries reported (Table 2). 

This study demonstrated that children have the greatest propensity to present to the emergency department with burn injuries sustained from hair styling tools, particularly from hair curlers and curling irons. The characteristics of the injury pattern described provides an opportunity for targeted anticipatory guidance to educate families regarding the hazard of electric hair styling tools. Specifically, parents should be counseled with regards to the appropriate ages for children to be able to use these tools independently and without supervision. 

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METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Electric Hair Styling Products Common Cause of Burn Injuries in Children

ARTICLE PUBLICATION DATE

20-Oct-2023

 WHY SCHOOLS NEED NURSES NOT COPS

Adolescents and young adults of all identities open to discussing sexual identity and gender identity with doctors

Survey shows that most teenagers are open to frank conversations with doctors or nurses about sex and gender

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— Teenagers and young adults are fairly open to the idea of talking with their doctors and nurses about their sexual orientation and gender identity and are okay being asked through various methods, whether on paper, electronically, or in person, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center. 

This is one of the first studies to establish how adolescents would prefer to broach this sensitive subject while visiting their health care provider. Gender-diverse and lesbian, gay, and bisexual youth are far more open to having these personal conversations with health care providers than their straight and cisgender peers, according to the research abstract.

Researchers who wrote the abstract, “Asking Adolescents and Young Adults about their Sexual Orientation and Gender Identity: Lessons for Clinic Staff and EHR Documentation,” surveyed 260 youth, ages 10 to 26, and found that nearly 70% were comfortable with being asked about their sexual orientation and gender identity during medical visits.  

“Our study showed that teenagers are remarkably open to discussing their sexual orientation and gender identity through various methods when visiting their doctor’s office. This finding emphasizes the importance of creating diverse avenues for communication, whether in-person or through virtual or paper registration forms,” said Jessica Pourian, MD, who conducted her research as a pediatric resident at Hasbro Children’s Hospital in Providence, Rhode Island and is now a clinical informatics fellow at the University of California, San Francisco. “By facilitating these discussions, we can foster an inclusive healthcare environment that ultimately leads to more effective and tailored care for our young patients.”  

While 64% of all youth agreed that it is important for health care providers to ask about their gender identity, chosen name, and pronouns, gender diverse youth were far more comfortable with that conversation (83%) compared with their cisgender peers (45%). Lesbian, gay, and bisexual youth were also more open to conversations about sexual orientation—56% compared to 38% of heterosexual youth. Over 96% of gender-diverse youth expressed a desire to have their chosen name and pronouns displayed in electronic health records, available to all medical staff. 

“When health care providers make assumptions about patients’ sexual orientation or gender identity, they miss opportunities for screening, risk causing distress, and can damage patient-provider relationships,” Dr. Pourian said. “This research shows that clinics should focus on integrating conversations about sexual orientation or gender identity into their practice to provide better and more comprehensive care to teenagers and young adults.” 

Dr. Pourian is scheduled to present her research, which is below, from 12 to 12:45 PM Monday, Oct. 23, during session H4051. To request an interview with the authors, contact Dr. Pourian at jessica.pourian@gmail.com. 

In addition, Dr. Pourian is among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference on Sunday, Oct. 22, from 8-9 a.m. ET in the National Conference Press Room 102 AB. During the meeting, you may reach AAP media relations staff in the press room. 

 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

 

# # #

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Submission Type: Section on LGBT Health and Wellness

Abstract Title: Asking Adolescents and Young Adults about their Sexual Orientation and Gender Identity: Lessons for Clinic Staff and EHR Documentation

Jhanavi Kapadia

North Attleboro, MA, United States

When healthcare providers make assumptions about patients’ sexual orientation or gender identity (SOGI), they miss opportunities for screening, risk causing distress, and can damage patient-provider relationships. Previous studies of gender diverse (GD) and lesbian, gay, and bisexual (LGB) adults have reported high levels of acceptance with their SOGI data being assessed and documented in the electronic health record (EHR), but less is known about adolescent and young adult (AYA) perspectives. Our study aimed to identify preferred approaches to collecting and documenting SOGI data from AYA.

This study was conducted at an academic adolescent medicine clinic in the northeastern United States between November 2022 to February 2023. Patients presenting to the clinic, which included four programs (primary care, gender, eating disorder, gynecology/menstrual health), were recruited. Participation was anonymous and voluntary. Paper questionnaires were administered by a medical assistant upon check-in during in-person visits. Demographics included SOGI and age. Likert scales were used to assess perceived importance of provider or staff assessing their SOGI and preferred method of assessment (via tablet, physician, etc.). Responses were entered into a REDCap database. All comparisons were performed using Pearson’s chi-squared or Fisher’s exact test where appropriate. All tests were two-sided; p-values < 0.05 were considered statistically significant. Patients were classified as GD and/or LGB based on responses.

Two hundred and sixty patients completed the survey, ages 10 to 26 (most common age category 18-20, 32%). Fifteen percent of respondents were from the eating disorder program, 43% from gender, 34% from primary care, and 7% from gynecology/menstrual health. Overall, 129 (50%) were GD and 136 (52%) were LGB. Ninety-nine patients (38%) identified as both GD and LGB. Sixty four percent agreed it was important for providers to ask about gender identity, chosen name, and pronouns. More GD youth compared to cisgender youth agreed that asking about this data was important (83% v 45%, p< 0.001). Asking about sexual orientation was perceived as less important compared to gender identity. More LGB youth agreed with the importance of asking about sexual orientation compared to heterosexual youth (56% v 38%, p< 0.02). Seventy percent of AYA were comfortable being asked about their SOGI, and no single method was preferred over another. Over 96% of GD youth wanted their chosen name and pronouns displayed in EHRs.

Most AYA are comfortable being asked for their SOGI data in a healthcare setting. GD and LGB youth expressed higher rates of comfort than their cisgender and heterosexual peers for SOGI questions respectively. AYA did not have a preference on the SOGI collection method. Clinics should focus on integrating SOGI collection into their practice to provide more comprehensive care to AYA.

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METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Adolescents and Young Adults of all Identities Open to Discussing Sexual Identity and Gender Identity with Doctors

ARTICLE PUBLICATION DATE

20-Oct-2023

 

Father’s postpartum depression doubles child’s odds of adverse childhood experiences before age 5 

Adverse childhood experiences – or ACEs- can have lifelong negative impacts on health and wellbeing 

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

  

Washington, D.C.—A father’s depression during his child’s first year of life has been associated with difficulties in parenting and child behavior, but new research finds that it also doubles the odds of a child having three or more adverse childhood experiences by age 5.  

Adverse childhood experiences (ACEs), which include household dysfunction and child maltreatment, can have lifelong effects on children that include health problems, poorer mental health, and lower school performance. The author of the abstract, “Paternal postpartum depression and children’s adverse childhood experiences at age 5,” will present additional preliminary findings during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.   

“Paternal depression is underdiagnosed, and pediatricians are in a unique position to link fathers to appropriate supports that can benefit themselves and their families,” said author Kristine Schmitz, MD, assistant professor of Population Health, Quality Improvement and Implementation Science at Rutgers Robert Wood Johnson Medical School.   

She analyzed data on 1,933 father/child dyads from the Future of Families and Child Wellbeing Study, a national U.S. urban birth cohort. About 75% of the parents were unmarried. The study investigated associations between depression in fathers in the first year of their child’s life and adverse childhood experiences when they transitioned into kindergarten.   

Children had two times the odds of experiencing three or more adverse childhood experiences by the time they were 5 years old, a risk that went beyond sociodemographic factors and mother’s postpartum depression, Dr. Schmitz said.    

“These preliminary findings demonstrate a robust association between father’s postpartum depression and later adversity for their children,” she said. “This suggests that fathers should be screened for depression and be offered treatment for their depression and that this may reduce the risk the hardships their children may later face.”  

This work was supported by the National Center for Advancing Translational Sciences; the U.S. Department of Health and Human Services/Health Resources and Service Administration; and the Robert Wood Johnson Foundation through its support of the Child Health Institute of New Jersey.  

Dr. Schmitz is scheduled to present her research, which is below, from 2-4 p.m. on Sunday, Oct. 22 during session H2035. To request an interview with the author, contact Jennifer Forbes, associate director of public relations for Rutgers Robert Wood Johnson Medical School at jenn.forbes@rwjms.rutgers.edu or Cell: 732-788-8301.  

In addition, Dr. Schmitz will be among highlighted abstract authors will give brief presentations and be available for interviews during a press conference from noon-1 p.m. ET Saturday, Oct. 21,  in the National Conference Press Room, 102 AB. During the meeting, you may reach AAP media relations staff in the press room. 

Please note: Only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.    

 

# # #  

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

 

ABSTRACT 

Program Name: AAP National Conference & Exhibition 

Submission Type: Council on Community Pediatrics 

Abstract Title: Paternal postpartum depression and children’s adverse childhood experiences at age 5. 

Kristine Schmitz 

New Brunswick, NJ, United States 

Paternal depression is associated with child behavior problems and problematic parenting, yet little is known about its association with subsequent child adverse childhood experiences (ACEs). We investigated associations between depression in fathers of infants and children’s ACEs at age 5, an important developmental stage. 

We analyzed data on 1933 father/child dyads from the Future of Families and Child Wellbeing Study, a national U.S. urban birth cohort. By design, ~75% of the mothers were unmarried. Paternal depression was assessed using a validated instrument when the child was 1-year old and children’s ACEs were reported by their mothers 5 years later. ACEs included 5 measures of household chaos (father absence, maternal depression, substance use, 

incarceration, violence towards caregiver) and 4 types of child maltreatment (psychological, neglect, physical, sexual). We used measures of overall exposure to ACEs (>=1 ACE, >=2 ACEs, 3+ ACEs) as well as specific ACEs. We estimated unadjusted and adjusted logistic regression models of associations between paternal depression and ACEs. Adjusted models controlled for father, family, and child characteristics and maternal depression. 

Of the 1933 father/child dyads analyzed, about half of fathers were non-Hispanic Black (48%), 64% had a high school education or lower, and 50% of births were paid for by Medicaid. Nine percent of the fathers experienced depression during the year after their children were born and 70% of the children experienced at least one ACE at 5 years. Children whose fathers had depression at 1-year had higher odds of ACEs than those whose fathers did not have depression. In unadjusted logistic regression models, children whose fathers had depression at 1-year had almost 3 times higher odds of any ACEs (OR 2.94, CI 1.88-4.62) and over 2 times higher odds of 3+ ACEs (OR 2.40, CI 1.72-3.36). In adjusted models, associations remained robust with an OR of 2.35 (CI 1.45-3.81) for any ACEs and 2.04 (CI 1.42-2.93) for 3+ ACEs. 

Children whose fathers experienced postpartum depression were significantly more likely to experience multiple ACEs at 5 years, above and beyond maternal postpartum depression and other potentially confounding factors. The preliminary findings show a robust association between fathers’ postpartum depression and subsequent adversity for their children. Expanding maternal and child health policy and practice to include fathers and early identification with robust intervention for paternal depression may stave off childhood adversity. 

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METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Father’s Postpartum Depression Doubles Child’s   Odds of Adverse Childhood Experiences Before Age 5

ARTICLE PUBLICATION DATE

20-Oct-2023

 

Live streaming platform ‘Twitch’ poses risks for minors who may be manipulated, preyed upon: New research 

Research presented during the 2023 AAP National Conference & Exhibition reviews ways youth use the live platform and interact with adult strangers 

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

 

Washington, D.C.— A popular live streaming platform, Twitch, poses risks to minors who can interact with adult strangers and donate money to streamers without the supervision of a parent or guardian, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.  

The abstract, “Predator Paradise: Analyzing the Ease of Accessibility to Minors on Twitch,” found that young users feel a false sense of safety on the platform, as a significant proportion were willing to reveal personal information despite having no knowledge of who might be listening. The nature of the live streaming platform makes it particularly risky, as there is no way to take back information that minor streamers reveal while on Twitch.  

“Twitch is an exciting platform; however, it may present hidden dangers for minor users,” said Ruth Milanaik, MD, FAAP, principal investigator of the study.  

“Parents need to supervise all interactions on this platform to best protect their child.”  

To conduct the research, trained coders entered Twitch.tv, searched popular video games and scrolled to view current live streams that appeared to be conducted by minors and who had their cameras on and showed their faces. No accounts were created for this study. The participants analyzed data collected on 100 minor Twitch streamers with 1,755,452 followers. Youth streamers provided their names (47%) and stated their location 50% of the time. About 38% provided detailed schedules of when they would be live, and 64% linked and encouraged viewers to follow their other public social media. Viewers were able to donate money to 37% of streamers. 

“The donation system is quite scary to me,” said Fiona Dubrosa, visiting scholar at Cohen's Children Medical Center, Northwell Health in Rego Park, N.Y. “The idea that anyone can donate money to streamers of any age seems very manipulative, and I do not think that it is widely known of the disturbing ways this could be utilized. Twitch must create a safer platform." 

The researchers conclude that popular websites like Twitch can serve as a breeding ground for voyeuristic consumption of underage streamers, and encourage pediatricians and caregivers to be aware of the potential dangers to children. 

The authors state that they did not receive financial support for this research but that it was conducted by the Teen Trends Consortium at Cohen's Children Medical Center, Northwell Health. Teen Trends Consortium is a group of researchers aged 18-24 that focuses solely on the most salient issues facing pediatric populations, including substance use and technology. 

Ms. Dubrosa is scheduled to present her research, which is below, from 8:28 AM – 8:34 AM Sunday, Oct. 22, 2023, during session H3009. 

To request an interview with the authors, contact Michelle Pinto, director of media relations, at Northwell Health at mpinto@northwell.edu. 

In addition, Ms. Dubrosa will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from 8-9 a.m. Sunday, Oct. 22 in the National Conference Press Room 102AB. During the meeting, you may reach AAP media relations staff in the press room. 

 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

# # #  

 

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Program Name: AAP National Conference & Exhibition

Submission Type: Council on Child Abuse and Neglect

Abstract Title: Predator Paradise: Analyzing the Ease of Accessibility to Minors on Twitch

Fiona Dubrosa

New York, NY, United States

Twitch.tv (“Twitch”) is a live online streaming platform where over 30 million people interact and view “creator-made” content. Live streamers must be older than 13 and have a valid email address/phone number to create an account. Concerningly, there are no age restrictions or identification requirements for viewers, potentially putting minors in danger of being watched, followed and groomed by predators. Followers get notified when streamers are live and viewers can donate money to streamers, which can make it easier for predators to manipulate, track, and encourage risky behaviors from minors. This study seeks to better understand the voyeuristic consumption possible via Twitch and its potential dangers to pediatric populations.

Trained coders entered Twitch.tv, searched popular video games (Fig. 1), and scrolled to view current live streams that appeared to be conducted by minors; only streamers who had their cameras on and showed their faces were included. No accounts were created for this study. The following data were collected: 1) video game; 2) age; 3) name; 4) follower count; 5) location; 6) streaming schedule; 7) social media (Fig. 2); 8) links to donate money; 9) topics discussed by streamers; 10) time it took to find minors under each game. Descriptive analysis was conducted in R.

A total of 100 minor Twitch streamers with 1,755,452 followers were analyzed. Youth streamers provided their names (47%) and stated their location 50% of the time. 38% provided detailed schedules of when they would be live, and 64% linked and encouraged viewers to follow their other public social media. Viewers were able to donate money to 37% of streamers. Discussions contained personal details 11% of the time, notably including streamers trying on outfits for viewers and discussing identifiable locations they frequent. It took between 12 to 297 seconds (4.95 minutes) to find minors in each game category.

Twitch represents a clandestine, threatening digital environment where minors are interacting with adult strangers without parental supervision. The nature of live streaming makes it particularly dangerous, as there is no way to take back information that has been revealed or regulate content or viewers. Young users clearly feel a false sense of safety on the platform; a significant proportion were willing to reveal personal information despite having no knowledge of who might be listening. The donation system provides a menacing avenue for manipulation and continued exploitation of minors. Our findings reveal the need for stricter age limitations for streamers and more stringent identity verification of audience members on Twitch. Parents and pediatricians should be aware of the dangers presented by Twitch and other live streaming platforms and counsel children on best practices for internet safety.

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METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Live Streaming Platform ‘Twitch’ Poses Risks for Minors Who May be Manipulated, Preyed Upon: New Research

ARTICLE PUBLICATION DATE

20-Oct-2023

 

Child injuries due to high-powered magnet ingestion continue despite public education efforts and age restrictions

Research finds children from lower socioeconomic backgrounds less likely to swallow magnets, but require more significant treatment

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

 

Washington, D.C.— Despite efforts to educate the general public about the dangers of high-powered magnet toys, children continue to be injured by  the small, high-powered, rare-earth balls after they swallow them or insert them into their nose or ear— even in households where parents fully understood the dangers of the toys, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.

Researchers of the abstract, “Socioeconomic Disparities in Pediatric High-Powered Magnet Ingestion Epidemiology and Outcomes,” reviewed data of patients, age 21 and younger, from 2017-2019 with injuries from high-powered magnet ingestions/insertions. The data is from a retrospective cohort study with 25 U.S. children’s hospitals. Researchers previously found that these injuries are increasing despite age restrictions, warning labels, and educational public health campaigns explaining the dangers.

“High-powered, rare-earth magnetic balls or beads are often sold as fun, stress-relieving toys, but they are among the most dangerous toys when kids eat them. It doesn't matter what the child's socioeconomic or racial background is, whether the child is being watched, or if supervising adults know the magnets are dangerous – kids still manage to eat them and many of them need surgery to fix the internal damage caused by the magnets,” said Minna Wieck, MD, BA, FAAP, assistant professor of pediatric surgery, UC Davis Children's Hospital. “The only foolproof way to make sure these injuries don't happen is to keep these types of magnets away from kids.”

Of the 594 high-powered magnet exposures in the study, 74.3% were from higher socioeconomic backgrounds. Even though children from lower socioeconomic backgrounds are less likely to incur or seek care for a high-powered magnet exposure, the study found that those patients required more invasive procedures and surgeries, longer hospital admission, and more readmissions to save their lives.

The research also found that the circumstances around the injuries were different among children from lower or higher socioeconomic backgrounds. For example, children from lower socioeconomic backgrounds were less likely to have been directly supervised by a caregiver at the time of exposure. Conversely, children from higher socioeconomic backgrounds were more likely to have parents who knew that these rare-earth, high-powered magnet toys can be dangerous when swallowed. There was no difference in the time caregivers took to seek care or the size or number of magnets children swallowed or inserted.

"Parents almost never think their kid will ‘be so dumb as to swallow’ magnets. But kids are doing so more often, despite adult supervision and even when adults know that these magnets are potentially dangerous,” Dr. Wieck said. “Since risk is proportional to access, the safest way to prevent injuries is to remove high-powered magnets from any environment where children may be present.”

Study author Leah K. Middelberg, MD, FAAP, is scheduled to present their research, which is below, from 3:25 - 3:32 PM Sunday Oct. 22,2023 at the Council on Injury, Violence, and Poison Prevention program. To request an interview with the authors, contact Dr. Middelberg at Leah.Middelberg@nationwidechildrens.org.

In addition, Dr. Middelberg is among highlighted abstract authors who will give a brief presentation and will be available for interviews during a press conference  Saturday, Oct. 21, from noon-1 p.m. ET in the National Conference Press Room 102 AB. During the meeting, you may reach AAP media relations staff in the press room.]

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visits. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Submission Type: Council on Injury, Violence, and Poison Prevention

Abstract Title: Socioeconomic disparities in pediatric high-powered magnet ingestion epidemiology and outcomes

 

Minna Wieck

Sacramento, CA, United States

High powered magnets are an increasingly frequent cause of unintentional injury in children. Despite the recent passage of regulations limiting the production of these magnets, ongoing advocacy and public education regarding the dangers of these products is needed. Such efforts are limited by the lack of data on how socioeconomic status (SES) impacts the incidence and prevention of these injuries. Thus, the goal of this study is to describe SES-associated differences in high powered magnet exposures.

In this multicenter, retrospective cohort study from 25 US children’s hospitals from 2017-2019, patients aged 0-21 years with a confirmed high-powered magnet ingestion or insertion were included. Details regarding demographics, exposure, injury, and treatment were collected. Children were grouped into SES groups based on zip code using the geocoded Childhood Opportunity Index (COI). Clinical characteristics and outcomes were compared between children with low (0-40) and high (41-100) COI scores.

594 patients with a high-powered magnet exposure were identified, of which 74.3% occurred among children with high COI scores. Children with a low COI score were less likely to have been directly supervised by a caregiver at the time of exposure (11.3% vs 17.4, p=0.047). Fewer parents in the low COI group (10.6 vs 19.4%, p=0.44) knew that magnets were dangerous. More children with a low COI had an injury compared to those with a high COI, although the difference was not statistically significant (13.2 vs 8.4%, p=0.08). Children with a low COI score were more likely to undergo both endoscopy and surgery (9.3 vs 2.9%, p=0.001), had a longer mean length of stay (4.4 days vs 3.3 days, p=0.007), and were more likely to require readmission (5.4 vs 1.6%, p=0.04) compared to those with a high COI score. Notably, there was no statistically significant difference in the time caregivers took to seek care; the time to the definitive care hospital; or the size or number of magnets per exposure.

Children with a higher SES account are more likely to have a high-powered magnet exposure, but children with a lower SES require more invasive procedures for treatment, longer stays in the hospital, and more readmissions  Caregivers across all SES groups need to be more aware of the danger these magnets pose, but these data illuminate opportunities for focused advocacy and education.

 

 

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METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Child Injuries Due to High-Powered Magnet Ingestion Continue Despite Public Education Efforts and Age Restrictions

ARTICLE PUBLICATION DATE

20-Oct-2023

RACIST MEDICINE KILLS

Research finds Black children over twice as likely to die of sepsis at one hospital

Black children 2.5 times more likely to die of sepsis compared to white children at Arkansas hospital

Reports and Proceedings

AMERICAN ACADEMY OF PEDIATRICS

Washington, D.C.— A retrospective analysis of pediatric sepsis deaths at a large hospital in Arkansas found that Black children in the hospital were 2.5 times more likely to die of sepsis than white patients, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.  

Researchers who wrote the abstract, “Racial Disparity in Pediatric Sepsis Mortality,” conducted a retrospective analysis of all patients at Arkansas Children’s Hospital (ACH) with sepsis, severe sepsis, or septic shock between January 2018 and April 2022. Researchers found 3,514 patients had sepsis during the study period with an overall mortality rate of 1.65%. Mortality was 3.13% in Black children versus 1.27% in white children, revealing that black children were far more likely to die of sepsis. 

“Early recognition and resuscitation of pediatric sepsis has led to improved outcomes. Despite these advancements, Black children continue to have increased mortality rates,” said lead study author Michael Stroud, MD, FAAP, professor, Pediatric Critical Care University of Arkansas for Medical Sciences, Arkansas Children’s Hospital Little Rock. “We must identify the factors contributing to this discrepancy and work to improve outcomes for all children, despite race, ethnicity, and socioeconomic status.” 

Many hospitals and health centers have made advancements in how they respond to sepsis, which is a deadly emergency health risk. Today, many hospitals, like ACH, use automated, real-time, algorithm-based detection of sepsis, severe sepsis, and septic shock incorporated into the electronic medical record. This method leads to earlier recognition, resuscitation, and improved outcomes.  

However, despite improvements in early recognition and resuscitation, sepsis remains a major pediatric health issue with an estimated 40,000 hospitalizations and 5,000 deaths every year in the US.  

"Our research shows that mortality in black children remains higher when compared with white children, despite advances like automated recognition tools and timely administration of therapeutic interventions," Dr. Stroud said. “Further investigations are needed to identify if conscious and unconscious biases, potential socio-economic factors, and genetic predispositions are leading to racial disparities in outcomes of children with pediatric sepsis, severe sepsis, and septic shock.” 

This work was internally funded by the Arkansas Children’s Hospital. 

Dr. Stroud is scheduled to present his research, which is below, from 11:15 to 12:15 p.m. Saturday, Oct. 21, 2023, during session H2020. To request an interview with the authors, contact Michael Stroud, MD, at stroudmichaelh@uams.edu. 

 Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

# # #  

 

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

 

ABSTRACT 

Submission Type: Section on Critical Care  

Abstract Title: Racial Disparity in Pediatric Sepsis Mortality  

Michael Stroud  

Little Rock, AR, United States  

Despite improvements in early recognition and resuscitation, sepsis remains a major pediatric health issue with an estimated 40,000 hospitalizations and 5,000 deaths every year in the US. Many centers now use automated, real-time, algorithm-based detection of sepsis, severe sepsis, and septic shock incorporated into the electronic medical record (EMR). This method leads to earlier recognition, resuscitation, and improved outcomes. Recent data shows a continued discrepancy in sepsis outcomes based on race, despite improvements in outcomes among children overall. We hypothesized that mortality rates remain higher in black children with sepsis, severe sepsis, and septic shock compared to white children, despite incorporation of automated screening tools into the EMR.  

A retrospective analysis of all patients at Arkansas Children’s Hospital (ACH) with sepsis, severe sepsis, or septic shock between January 2018 and April 2022 was conducted. ACH uses a best practice advisory (BPA) in the EMR for early detection in all hospital areas including the emergency department, all medical-surgical wards, all Intensive Care Units (ICU), and interfacility transport. EMR activation leads to a bedside huddle, followed by institution of clinical interventions. A sepsis episode (SE) was defined as BPA activation or a diagnosis of sepsis, severe sepsis, or septic shock in the EMR. Mortality rates, as well as demographic information and clinical outcome measures for children who died were compared between Black(B) and White(W) children. Student's t-test was used for categorical variables, chi-square for proportions, and odds ratio for overall mortality comparison.  

3,514 patients had a SE during the study period; 2126(W) and 736(B). Overall mortality was 1.65% (40%(B); 47%(W)). Mortality was 3.13% (23/736) in Black children versus 1.27% in White children; OR 2.51 (1.43,4.40), p=0.001. Basic demographics including gender (Female-56.52%(B), 55.56%(W); p=0.95) and age in years (8.00+/-2.78(B), 7.87+/-2.66; p=0.97) were similar. Clinical interventions including total IV antibiotic days (23.83+/-8.36(B), 21.56+/-9.59(W); p=0.38), vasoactive infusion days (2.17+/-1.44(B), 2.63+/-0.90; p=0.18), and percent requiring Extracorporeal Membrane Oxygenation (26.07%(B), 18.52%(W), p=0.52) were similar. Black children who died had a longer length of hospitalization (16.70+/-6.47(B), 12.70+/-5.85(W) days; p=0.03) and longer ICU stay (7.57+/-2.57(B), 5,70+/-2.27(W) days; p=0.01). Percent over threshold for antibiotic administration (21.74%(B), 18.52%(W); p= 0.78; 1h-septic shock, 3h-sespis) and IV fluid bolus administration (8.70%(B), 14.81%(W); p=0.51; 20 minutes-septic shock, 1h-sepsis) were similar.  

This single center, retrospective study shows that hospitalized Black children have a 2.5 times greater risk of death from sepsis compared to White children. Interestingly, this preliminary data suggests similar rates of timely resuscitation including antibiotic administration and IV fluid boluses. Further investigations are needed to identify biases (conscious and unconscious), potential socio-economic factors, and genetic predispositions leading to racial disparities in outcomes of children with pediatric sepsis, severe sepsis, and septic shock.  

 

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ARTICLE TITLE

Research Finds Black Children Over Twice as Likely to Die of Sepsis at One Hospital

ARTICLE PUBLICATION DATE

20-Oct-2023