Rita Marie John

The effect of breastfeeding on childhood overweight and obesity: A systematic review of the literature

Background Childhood obesity has reached epidemic proportions. There is increasing attention to the topic of prevention and continued debate as to whether breastfeeding (BF) is protective against childhood obesity. Previous systematic reviews on this topic were done in 2005 showing that BF was protective against childhood obesity but, because of confounding variables, the evidence was weak. Objective To explore the current evidence of the effect of BF on childhood obesity and provide recommendations for the nurse practitioner (NP) as a primary care provider. Methods A systematic review of the literature from 1/2005 to 3/2012 was done to assess the evidence on the relationship between BF and childhood obesity. Results The majority of studies identified in this article showed a relationship between BF and obesity prevention, but because of confounding maternal, child, cultural, genetic, and environmental variables, the relationship remains unclear. Conclusions While it is possible that there are protective benefits of BF on childhood obesity, it is difficult to prove because of confounding variables. However, because of other benefits for the mother and child, BF should be encouraged. Whether obesity in childhood can be prevented by BF remains unclear. Further research controlling for confounding variables is needed to provide concrete evidence.Background: Childhood obesity has reached epidemic proportions. There is increasing attention to the topic of prevention and continued debate as to whether breastfeeding (BF) is protective against childhood obesity. Previous systematic reviews on this topic were done in 2005 showing that BF was protective against childhood obesity but, because of confounding variables, the evidence was weak. Objective: To explore the current evidence of the effect of BF on childhood obesity and provide recommendations for the nurse practitioner (NP) as a primary care provider. Methods: A systematic review of the literature from 1/2005 to 3/2012 was done to assess the evidence on the relationship between BF and childhood obesity. Results: The majority of studies identified in this article showed a relationship between BF and obesity prevention, but because of confounding maternal, child, cultural, genetic, and environmental variables, the relationship remains unclear. Conclusions: While it is possible that there are protective benefits of BF on childhood obesity, it is difficult to prove because of confounding variables. However, because of other benefits for the mother and child, BF should be encouraged. Whether obesity in childhood can be prevented by BF remains unclear. Further research controlling for confounding variables is needed to provide concrete evidence.

The effect of a mobile clinical decision support system on the diagnosis of obesity and overweight in acute and primary care encounters.

The purpose of the study was to compare the proportion of obesity-related diagnoses in clinical encounters (N = 1874) documented by nurses using a personal digital assistant-based log with and without obesity decision support features. The experimental group encounters in the randomized controlled trial had significantly more (P = .000) obesity-related diagnoses (11.3%) than did the control group encounters (1%) and a significantly lower false negative rate (24.5% vs 66.5%, P = .000). The study findings provide evidence that integration of a decision support feature that automatically calculates an obesity-related diagnosis increases diagnoses and decreases missed diagnoses and suggest that such systems have the potential to improve the quality of obesity-related care.

Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure

Purpose This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Data sources Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). Conclusions While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on childrens intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Implications for practice Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.Purpose: This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Data sources: Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). Conclusions: While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on childrens intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Implications for practice: Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.

everything the nurse practitioner should know about pediatric feeding tubes

Purpose To provide an overview of the current feeding tubes in use in the pediatric population including feeding tube complications, and specific guidance for patients at the initiation, throughout the use of, and at the discontinuation of tube feeding. Data sources A review of the literature was performed using multiple databases including PubMed, CINAHL, Ovid Medline, and Cochrane Library. Key words used included pediatric gastrostomy (G) tubes, nasogastric (NG) tubes, gastrojejunostomy (GJ) tubes, enteral access, and nurse practitioner (NP). Conclusions Any child who cannot obtain nutrition orally is a candidate for enteral feeding tube access. Tube feeding is the recommended care guideline for children that are undernourished or unable to safely take-in oral nutrition. Tube feeding has been known to improve health-related quality of life. There are a number of different forms of feeding tubes that can be used in children, including NG, orogastric, G, and GJ tubes. Implications for practice Children are being sent home regularly with enteral feeding tube access and NPs will encounter these patients in everyday practice. It is important that NPs know the risks and benefits of tube feeding as well as the types of tubes currently in use and their indications, advantages, disadvantages, and complications.Purpose: To provide an overview of the current feeding tubes in use in the pediatric population including feeding tube complications, and specific guidance for patients at the initiation, throughout the use of, and at the discontinuation of tube feeding. Data sources: A review of the literature was performed using multiple databases including PubMed, CINAHL, Ovid Medline, and Cochrane Library. Key words used included pediatric gastrostomy (G) tubes, nasogastric (NG) tubes, gastrojejunostomy (GJ) tubes, enteral access, and nurse practitioner (NP). Conclusions: Any child who cannot obtain nutrition orally is a candidate for enteral feeding tube access. Tube feeding is the recommended care guideline for children that are undernourished or unable to safely take‐in oral nutrition. Tube feeding has been known to improve health‐related quality of life. There are a number of different forms of feeding tubes that can be used in children, including NG, orogastric, G, and GJ tubes. Implications for practice: Children are being sent home regularly with enteral feeding tube access and NPs will encounter these patients in everyday practice. It is important that NPs know the risks and benefits of tube feeding as well as the types of tubes currently in use and their indications, advantages, disadvantages, and complications.

Unaccompanied Immigrant Minors: Where to Begin

The number of unaccompanied immigrant minors (UIMs) from Central America significantly increased in 2014. Nearly 50,000 children from El Salvador, Guatemala, and Honduras crossed the United States-Mexico border in 2014, compared with 3,933 in 2011. Few resources exist to guide pediatric nurse practitioners (PNPs) in their care of UIM. The multifactorial reasons behind migration and the state of childrens health in Central America provide insight into the needs of UIMs. Guidelines for similar groups such as foreign-born children and refugees offer direction for the health care considerations of UIMs. This article provides demographic information on UIMs, highlights the unique and challenging medical and mental health issues facing UIMs, and discusses the role of the PNP. A UIMs initial visit with a PNP serves as an opportunity to build trust through culturally competent, trauma-informed care, provide preventive care, assess for unmet health needs, and screen for mental health conditions.

Early Identification of Tethered Cord Syndrome: A Clinical Challenge

Tethered cord syndrome (TCS) is a progressive clinical condition that arises from excessive spinal cord tension. The clinical signs and symptoms of TCS may be cutaneous, neurologic, musculoskeletal, genitourinary, and/or gastrointestinal. Patients also may be asymptomatic, which does not exclude the diagnosis of TCS. Although the exact etiology is unknown, early identification and lifelong surveillance or surgical treatment is an essential component of patient management. In this article we review the pathophysiology, various etiologies, clinical presentation, and long-term sequelae of TCS. This information will help pediatric nurse practitioners identify TCS early and anticipate the patients needs and management requirements.

Predictors of Depression Screening Rates of Nurses Receiving a Personal Digital Assistant-based Reminder to Screen

The purpose of this study was to determine if race/ethnicity, payer type, or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen. The sample comprised 4,160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire (PHQ)-2/PHQ-9 integrated into a personal digital assistant-based clinical decision support system for depression screening and management. Nurses chose to screen in response to 52.5% of reminders. Adjusted odds ratios showed that payer type and nurse specialty, but not race/ethnicity, significantly predicted proportion of patients screened.

Understanding Disorders of Sexual Development

Studies estimate that the incidence of genital anomalies could be as high as 1 in 300 births. While it is rare for an infant to present with truly ambiguous genitalia, it is plausible that the pediatric nurse will encounter a patient with disorders of sexual development in his or her career. Cases of disorders of sexual development are challenging due to complexities of diagnosis, gender assignment, uncertain outcomes, treatment options, and psychosocial stressors. This article discusses the evaluation and management of children with disorders of sexual development and the nurses role as child advocate and family educator.

Jaw disorders in the pediatric population.

PURPOSE This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics. DATA SOURCES A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015. CONCLUSIONS Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided. IMPLICATIONS FOR PRACTICE TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.

Anti–N-Methyl-D-Aspartate Receptor Encephalitis in Children and Adolescents

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is becoming increasingly recognized in the pediatric population. It may be the most common cause of treatable autoimmune encephalitis. The majority of cases of anti-NMDAR encephalitis are idiopathic in etiology, but a significant minority can be attributed to a paraneoplastic origin. Children with anti-NMDAR encephalitis initially present with a prodrome of neuropsychiatric symptoms, often with orofacial dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death. Definitive diagnosis requires detection of NMDAR antibodies in the cerebrospinal fluid. Optimal outcomes are associated with prompt removal of the tumor in paraneoplastic cases, as well as aggressive immunosuppressive therapy. Early detection is essential for increasing the chances for a good outcome. Close follow-up is required to screen for relapse and later onset tumor presentation. The nurse practitioner plays a major role in the research, screening, diagnosis, treatment, follow-up, and rehabilitation of a child or adolescent with anti-NMDAR encephalitis.