2 AAP News •
www.aapnews.org • September 2015
♦ Korah N, et al. Pediatrics. 2015;136: 4-5,
The Montreal Children’s Hospital Champions for Patient Safety set up a “Crib of Horrors” to show potential hazards to hospitalized
infants and children. The crib traveled around
the hospital for a week, and staff members and
patients were encouraged to view the crib and
list all of the hazards they saw.
Three physicians started the Champions for
Patient Safety after patient and staff satisfaction surveys showed that the hospital’s safety
culture needed improvement. The group’s goal
is to facilitate discussions and educational opportunities regarding patient safety.
The group devised the Crib of Horrors to
be displayed during Canadian Patient Safety
Week, which is around Halloween. An infant
or child mannequin was placed in the crib and
was surrounded by numerous hazards and safety errors such as used, uncapped needles; an
orogastric feeding tube taped over the infant’s eye;
excess tubing that could strangle the infant; and the
wrong patient chart.
During patient safety week, the crib traveled to
inpatient, outpatient and waiting areas. More than 80
physicians, nurses, students, patient care attendants,
The authors noted that the activity was inexpensive
and easy to set up, and garnered a lot of positive feed-
back. They said they hope other hospitals will create
cribs or beds of horror to encourage discussions of
by Carla Kemp • Senior Editor
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websites often unreliable
♦ Bryant-Comstock KR, et al. J Pediatr
Adolesc Gynecol. June 3, 2015, http://
Inaccurate or misleading information
about condoms, sexually transmitted infections (STIs) and other sexual health issues
was common on crisis pregnancy websites,
according to an analysis of 85 websites.
Crisis pregnancy centers, which counsel
women on alternatives to abortion, often provide free pregnancy tests and some offer STI
screenings. Center websites may be listed in
state resource directories, which implies that
the information found on the sites is reliable.
Researchers analyzed pregnancy center
websites listed in resource directories of 12
states with “Woman’s Right to Know” laws.
These laws require women to receive counseling and wait a specified period of time
before having an abortion. A previous study
showed that most pregnancy center websites
had inaccurate or misleading information on
abortion. This study looked at information
related to sexual health.
• About 64% of sites discouraged condom
use by stating that they break often and
are not effective.
• Less than 10% encouraged consistent and
correct condom use to prevent pregnancy
• Nearly half of the websites stated that
abstinence should be practiced until mar-
riage, and 45% said marriage is protective
• Nearly all of the websites (92%) had pic-
tures or videos of teens on their home
page, which indicated that they targeted
• Only two websites had information on
how to obtain hormonal birth control,
but none had information on the effec-
tiveness of these methods.
The authors noted that nearly 10 million
new cases of STIs occur each year in youths
15-24 years of age, according to the Centers
for Disease Control and Prevention. This situation could worsen if young people believe
that condoms are ineffective against STIs.
They recommended that reproductive
health advocates urge states to remove web-
sites with inaccurate information from their
‘Crib of Horrors’ helps promote patient safety
Soft cardiac murmurs rarely signal structural heart defect
♦ Kang G, et al. Arch Dis Child. June 12, 2015,
Most children (97.4%) with cardiac murmurs classified as soft on a grading scale had innocent murmurs, according to a prospective study of 81,213
children ages 5-13 years in China. In addition, the
prevalence of structural heart disease was much lower
in children older than 10 years of age.
Cardiac murmurs in asymptomatic children are the
most common reason for referral to a cardiologist and
may be the only indicator of serious heart disease.
Although echocardiogram can determine if structural
heart disease is present, it is not cost-effective to send
all children with murmurs for the test.
The authors of this study sought to determine
the prevalence and clinical significance of cardiac
murmurs heard during heart disease screening and
whether the screening contributed to the detection of
structural heart disease. Subjects included students in
all 32 elementary school in a city in southern China.
Parents completed a questionnaire on cardiovascu-
lar and valvular disease risk factors and cardiovascular
symptoms in their children. All students were exam-
ined by a cardiologist, and those with a definite or
possible murmur underwent echocardiogram. Mur-
murs were classified as soft (grades 1 and 2) or loud
Nearly every student in the city was screened
(81,213 of 81,231). Murmurs were detected in 2,193
children (2.7%), and 215 had structural heart disease.
Of those with murmurs, 1,797 (82%) had a grade
of 1 or 2.
The prevalence of structural heart disease was the
same in males and females and was higher in younger
children ( 3. 4 per 1,000 children ages 5-7 vs. 1. 7 per
1,000 children ages 11-13).
Nearly 84% of children with structural heart disease had cardiac murmur grades of 3 or greater. Furthermore, structural heart disease in children with
grade 1 or 2 murmurs was mostly clinically nonsignificant congenital heart defects.
The authors recommended performing echocar-diography in children younger than 10 years and in
those with a cardiac murmur loudness grade of 3 or
greater. They also stressed that echocardiogram is not
a replacement for a cardiovascular exam.
Pediatrics. 2015;136: 4-5.
A hospital patient safety team set up a traveling display to
raise awareness of hazards and safety errors that can endanger hospitalized infants and children.