Child Development Associate

To fulfill the promise of a life of dignity, autonomy, and independence for children and youth with special health care needs (CYSHCN) and their families, greater value must be assigned to meaningful outcomes, such as quality of life and well-being. Despite decades of research, programs, and measurements addressing quality of life and well-being for CYSHCN and their families, there still is no consensus on how to measure, implement, or achieve them. As the US health care system strives to reach the health care goals of safe, efficient, effective, equitable, timely, and patient-centered care, youth and families must be equal partners at all levels of the health care system-from clinical decision making to designing and implementing programs and policies. The health care system must systematically measure the priorities of CYSHCN and their families. It also must incorporate data on quality of life and well-being when developing services, supports, and systems that help CYSHCN and their families to flourish rather than hindering them.

Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18months, reinforcing the need for recurrent screening as autism emerges in early development.

Lepidopterism is a term that refers to a spectrum of medical conditions, typically involving the skin, that result from contact with the adult or larval forms of certain butterflies and moths. There are more than 165,000 species of these insects, however, only about 12 species are known to harm humans, most commonly in the form of contact dermatitis. Among these species, the Megalopyge opercularis, commonly called the "Puss Caterpillar", is known to cause a painful and pruritic cutaneous reaction when its venom encounters the skin. Although caterpillar stings are not a common etiology of dermatological rashes, physicians must perform a detailed history and have a high degree of suspicion to arrive to the correct diagnosis and avoid unnecessary medications and therapeutics. We present a case of a 14-month-old boy who presents to the pediatric clinic with a unilateral red rash on the anterior aspect of the left leg, from the distal thigh to the shin. The parents report that the boy was sitting in the park, when he suddenly started to cry. They state that the rash began to spread and that red marks are growing. The patient's parents brought the caterpillar specimen in a bag, clinching the diagnosis. The patient was treated with antihistamine drugs for symptom relief and was recommended to wash thoroughly the area with soap and water. The patient returned to the clinic four days later and the rash had resolved. When encountering an acute onset rash in a patient with recent exposure to nature environments and other open spaces with trees, lepidopterism should be considered in the differential diagnosis and promptly treated. Furthermore, the physician must educate the patients on how to avoid exposure, and special care should be implemented with asthmatic and atopic patients, because although rare, anaphylactic reactions to these stings have been reported.

ABSTRACTFine motor deficits are often correlated with poor handwriting which can impact a variety of academic-related tasks. Occupational therapists (OTs) frequently provide interventions for the remediation of handwriting difficulties. Evidence exists to provide information as to the most effective forms of interventions used by occupational therapists. However, what OTs do within a treatment session has yet to be defined and studied for effectiveness. This study provides an initial feasibility study to examine the method of text mining to explore and define the interventions used by occupational therapists in the treatment of fine motor skills as related to handwriting difficulties. Researchers performed a retrospective review of 157 participants’ narrative treatment notes using text mining. Data were categorized into treatment interventions based on five previously identified treatment categories. Pre and posttest fine motor scores were examined to determine change. Specific handwriting outcomes were not gathered at this time. Results revealed three primary treatment interventions for the treatment of handwriting difficulties multisensory and motor approaches. A significant change in pretest and posttest scores was indicated. Overall, therapists in this setting utilized evidence-based interventions that demonstrated significant changes in fine motor skills. The study exhibited limitations in the single site sample and size of the sample and no direct assessment of handwriting outcomes. Future research would expand the study to additional sites and further explore relationships between interventions and outcomes.