The new research was presented at AAP 2021, the American |Academy of Pediatrics Virtual National Conference & Exhibition, from October 8-11. The features below highlight some of the studies emerging from the conference.

“Baby-Wearing” Presents Serious Injury Risk for Infants

Previous studies have shown the benefits of “baby-wearing”—or carrying a child on one’s body using a sling, soft carrier, or another device— to include decreased crying. However, the practice also involves risks, such as when a baby falls out of the carrier or is injured when the adult carrying them falls. To assess the epidemiology of baby-wearing injuries in children who presented to emergency departments (EDs), researchers examined data from patients aged 5 and younger who experienced an injury related to a babywearing product during 2011-2020. Using 601 cases to produce national estimates, the study team found that approximately 14,024 patients presented to EDs for baby-wearing injuries during the study period, with 52% of the injuries occurring when a patient fell from the product. More than one-half the injuries—61%— occurred in children aged 5 months and younger, and 19.3% of infants required hospitalization, primarily for head injuries. An estimated 22% of the injuries were related to a caregiver falling. The analysis demonstrated the potential risks associated with baby-wearing devices, the researchers noted and highlighted the need for more education around baby-wearing products and improved safety standards.

Pandemic Affects Family Violence Patterns

The COVID-19 pandemic’s intensification of factors that increase the risk for interpersonal family violence—including parental stress, financial hardship, and isolation—prompted researchers to study the prevalence of, and circumstances leading to, adolescent injuries caused by this type of violence. The retrospective analysis of children aged 10-15 seen before or during the pandemic in an emergency department (ED) for injuries related to a violent incident with a family member included 819 events between January 2019 and December 2020. More than one-half (54.7%) involved a family member, and injuries occurred at a similar rate before compared with during the pandemic (54.6% vs 54.9%). Most events (83.9%) happened at home and involved a parent or guardian (76.6%); 66.7% resulted in police transport of the youth to the hospital. Study participants were more likely than the overall population of the ED to be Black individuals (84.4% vs 60.0%) and publicly insured (71.2% vs 60.0%). As the shift toward a post-pandemic life begins, investigators underscored the importance of identifying at risk families and providing resources to those in need, while also noting that the ED is an appropriate setting for this undertaking.

Bystander Actions Improve Drowning Outcomes

While research has demonstrated that early rescue and resuscitation help prevent severe injuries caused by drowning, the extent of benefit from bystander rescue for all cases of pediatric drowning remains unclear. To examine this question, investigators conducted a cross-sectional study of data on drownings and near-drownings in individuals younger than 18 from one US county. The analysis included 237 incidents from 2010- 2013 in which a young person was submerged; the median age was 3.2 years. Most events (78%) occurred in a swimming pool. Unfavorable outcomes—defined as death or severe impairment after hospital discharge—occurred in 16% of the study population and significantly correlated with being submerged for longer than 5 minutes. The odds of a poor outcome declined by 80% if a bystander attempted a rescue, regardless of whether they performed CPR (adjusted OR, 0.2). If a bystander conducted CPR, the odds of an unfavorable outcome fell by a comparable amount, though the difference was not statistically significant. The study team emphasized that the most important step a bystander can take is to remove a submerged child from the water, as that can prevent an initial respiratory arrest from progressing to a complete cardiopulmonary arrest.

Gender-Affirming Care “Can Save Lives”

The high rates of mental health issues among transgender and nonbinary young people, including depression and suicidal ideation, prompted researchers to examine the impact of gender-affirming care in this population. The study team tracked depression, anxiety, and suicidality in 104 transgender and nonbinary people aged 13- 21 who received care at a single-gender clinic between August 2017 and June 2018. In the cohort, 62.5% reported receiving mental health therapy and 34.7% reported some substance use. Participants completed the Patient Health Questionnaire and the Generalized Anxiety Disorder scale at baseline and at 3, 6, and 12 months, with the researchers defining severe depression and severe anxiety as a score of 10 or greater on either scale. At baseline, 56.7% of the cohort had moderate to severe depression, 43.3% reported thoughts of self-harm or suicidal ideation in the preceding 2 weeks, and 50.0% had moderate to severe anxiety. After 12 months of care, participants had a 60% reduction in depression and a 73% decrease in suicidality following adjustment for multiple factors, including the level of parental support and ongoing mental health therapy, among others.

Pediatricians Can Effectively Promote Gun Safety

Amid an increase in firearm sales and related injuries during the COVID-19 pandemic, as well as prior research demonstrating a reluctance among pediatricians to screen for firearms and provide counseling on gun safety, investigators examined the efficacy of a two-step educational program about firearms. The study team provided training on firearm safety and screening to members of a general pediatrics division and gave clinics free gun locks; they also distributed posters and educational cards. They evaluated the project through anonymous online surveys conducted among participating clinicians. Results showed that the program almost doubled screenings during well-child visits, from 37.8% to 72.4%, and markedly increased the number of families who received a firearm lock when they told clinicians they had a firearm at home, from 9.6% to 79.3%. The researchers emphasized the need for additional studies about how pediatricians can have the greatest impact regarding firearm counseling.