Background: The American Academy of Pediatrics (AAP) recommends the ABCs of safe infant sleep (alone, back, clear crib) to combat the increasing rates of Sudden Unexplained Infant Death (SUID). It is unclear if these recommendations are followed for infants hospitalized in pediatric facilities after the newborn period. The objectives of this study were to assess baseline infant sleep behaviors at a tertiary care freestanding pediatric hospital and to evaluate the effectiveness of a hospital-based infant safe sleep program in improving adherence to safe sleep recommendations. Methods: A quality improvement program with pre- and post- analyses was performed on a convenience sample of infants < 12-months old utilizing a crib audit tool on two general pediatric inpatient units. The crib audit tool was used before and after the safe sleep program intervention. It recorded the infant's sleep position, location during sleep, and sleep environment. Interventions included: 1) nursing education, 2) crib cards with a checklist of the ABC's of safe sleep provided for the cribs of hospitalized infants, and 3) tracking boards to report weekly measured compliance with the ABCs. Chi square analysis was used to compare adherence to recommendations before and after program implementation. Results: There were 62 cribs included pre-intervention and 90 cribs post-intervention. Overall, there was no significant change in safe sleep positioning (81% to 82%, p = 0.97). There was a significant increase in adherence to the safe sleep environment recommendation (3% to 38%, p < 0.01). Overall safe sleep, including both position and environment, referred to as ABC compliance, improved from 3% pre-intervention to 34% post-intervention (p < 0.01). Only 18% of cribs audited displayed a crib card, demonstrating poor compliance on placement of the cards. There was no significant difference in compliance with safe sleep recommendations between infants with a crib card compared to those without (25% vs. 37%, p = 0.51). Conclusions: Significant improvements were made in sleep environments and overall safe sleep compliance after introduction of crib cards and tracking boards. Most likely the crib auditing process itself and the tracking boards had a larger impact than the crib cards.

Objective Some experts recommend eliminating “teaspoon” and “tablespoon” terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, kitchen spoons), which are associated with dosing errors. We examined whether use of “teaspoon” or “tsp” on prescription labels affects parents’ choice of dosing tools, and the role of health literacy and language. Methods Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign. Results Seventy-seven percent had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either “tsp” or “teaspoon” units (alone or with “mL”) chose nonstandard dosing tools (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed “mL”-only labels (adjusted odds ratio [AOR]  = 4.4 [95% confidence interval (CI), 3.3–5.8]). Odds varied based on whether “teaspoon” was spelled out or abbreviated (“teaspoon”-alone: AOR = 5.3 [95% CI, 3.8–7.3] ); “teaspoon” with mL: AOR = 4.7 [95% CI, 3.3–6.5]; “tsp” with mL: AOR = 3.3 [95% CI, 2.4–4.7] ; P  <  .001). Similar findings were noted across health literacy and language groups. Conclusions Use of teaspoon units (“teas poon” or “tsp”) on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.

Screening toddlers for autism spectrum disorder (ASD) with the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) has been shown to lower age of diagnosis by 2 years. In order to streamline ASD screening, research is exploring the use of web-based screening during well-child checkups. The current study examined implementation of the web-based M-CHAT-R in an urban pediatric clinic in Atlanta, Georgia. Toddlers (N = 2557; 87% African American) were screened during well-child visits (M age = 22.43 months, SD = 3.65). Using the web-based version resulted in a 58.5% increase in the number of cases screened per month. A similar proportion of toddlers in each modality screened positive (P =.43), but significantly fewer children were missing "Follow-up" in the web-based administration (P < .001). These results suggest that it is feasible to implement web-based screening in underserved populations. Future research is necessary to understand factors that facilitate successful implementation of web-based ASD screening.