Can you recognize the signs of sepsis? They are confusion or disorientation, shortness of breath, high heart
rate, fever, shivering, feeling very cold,
extreme pain or discomfort, and clammy
or sweaty skin.
Sepsis has high morbidity and mortality among pediatric patients, with 60% of cases occurring in
children’s hospitals. But evidence suggests that children have a
better chance of survival and improved outcomes than adults.
Several resources are available for pediatricians and pediatric hospitals.
The Centers for Disease Control and Prevention (CDC) has
created materials as part of a Get Ahead of Sepsis awareness
campaign that pediatricians can use to educate families. Chil-
dren with chronic health conditions and those under age 1 are
particularly vulnerable to sepsis, which most often is caused
by infections from Staphylococcus aureus, Escherichia coli and
some types of Streptococcus. Current immunizations, proper
care for chronic health conditions, wound care and hand hy-
giene are particularly important to pre-
vent sepsis in these high-risk groups.
Find practice resources at www.cdc.
The AAP Section on Emergency
Medicine’s Septic Shock Collaborative
has been working on best practices to
prevent pediatric sepsis. Improving Pediatric Sepsis Outcomes,
available at http://bit.ly/2wEoiFF, is focused on reducing mortality and hospital-onset sepsis in participating hospitals by
75% by 2020.
The AAP Section on Critical Care is working with the Society
of Critical Care Medicine on the Surviving Sepsis Campaign,
which includes guidelines and information for severe sepsis
care. The campaign also offers a free Surviving Sepsis app that
includes a screening tool and treatment guidelines via Google
Play or i Tunes, http://bit.ly/2wGo6aB.
Find the AAP policy on sepsis in neonates at http://pediatrics.
aappublications.org/content/129/5/1006. Parent-friendly AAP
information is available at http://bit.ly/2wneJJs.
Need help explaining to
parents how children with
learning disorders, dyslexia
and attention-deficit/hyperactivity disorder (ADHD) see
Understood.org o;ers an interactive ;rough
Your Child’s Eyes simulation ( http://u.org/2w
Xtmp2) that allows people to experience what
it is like to have learning and attention issues,
specifically issues with reading (dyslexia), writing (dysgraphia), math (dyscalculia), attention
(ADHD) and organization (executive function).
;e experience is tailored
to the child’s grade level and
includes videos of children explaining how it feels to have
the learning or attention issue.
An expert explanation of the
issue follows. Next, parents can play an interactive game that shows what a child with that
learning or attention issue would experience.
;e tool is one way to help make learning and
attention issues more visible during the AAP-sup-ported Learning Disabilities, ADHD and Dyslexia Month.
Report on consent of minors looks at
impact on ED physicians
need care in a disaster
or during a personal
crisis sometimes enter the emergency
without a parent or
A new policy resource and education
paper helps ED physicians navigate legal
and other nuances.
Treatment of Minors, from the American College of
Emergency Physicians (ACEP) Pediatric Emergency
Medicine Committee, is published in the Annals of
Emergency Medicine ( http://dx.doi.org/10.1016/j.
annemergmed.2017.06.039). ;e paper parallels
many points in the 2011 AAP policy statement
Consent for Emergency Medical Services for Children
and Adolescents ( http://bit.ly/2iFEljq).
;e ACEP paper places an emphasis on federal and state laws
that apply to physicians’ care decisions, said Joseph Wright, M.D.,
M.P.H., FAAP, chair of the AAP
Committee on Pediatric Emergency Medicine.
Evaluation and Treatment of Minors is revision of a 1993 paper. It
includes new guidance on confidentiality, consent
and refusal of care in minors under age 18 who present to the ED without a parent or guardian.
Federal statute requires that unaccompanied
minors receive an initial examination or medical
screening examination and stabilization without delay. ;ere are some exceptions to the rule to obtain
legal parental consent for further care. ACEP notes
categories of conditions that minors can consent
for, with state examples. ;e report also addresses
electronic health record (EHR) challenges, confidentiality and how to document refusal of care.
;e AAP policy o;ers a slightly di;erent perspec-
tive, said Dr. Wright. “One thing we do focus on is
engagement of the whole family: child and parent.
You make every e;ort to involve the child, even if
they are not of consent-issuing age, in the care.”
Pediatricians who care for children outside the
ED can review both reports when developing their
practice’s disaster preparedness plans. ;ey also can
reference solutions to adolescent confidentiality
within the EHR, such as when a patient seeks re-
productive health services in a school-based clinic
environment, said Dr. Wright.
“;e No. 1 recommendation is to never withhold
necessary care because of concerns about consent,”
he said. “Our focus is the health and well-being of
Parenteral, enteral nutrition paper guides clinicians, schools
Proper nutrition is essential for all students to do their best in
school. This includes students who rely on parenteral or enteral
Resources for the Provision of Nutrition Support to Children
in Educational Environments from the American Society for Parenteral and Enteral Nutrition (ASPEN) fills an information gap to
help pediatricians, families and schools set up care guidelines
that meet students’ individual needs. It is available at http://
Children with complex nutritional therapy needs are more
susceptible to malnutrition, especially when they are away from
home during the school day. ASPEN recommends an Individualized Education Program that outlines how the instruction
will be adapted to meet a student’s unique needs. It notes the
importance of physician orders for students and emphasizes
the need for a partnership among parents, medical staff and
Making sure that a child does not feel stigmatized also is
crucial, the document said. This might include educating peers
to normalize their perspective of the child’s need for the medical
device. “The goal would be to provide emotional support for the
child receiving nutrition support and increase his or her comfort
and normalcy in the classroom setting, including addressing the
issue of bullying,” authors wrote.
Tables outline possible complications, signs and action steps
for central venous catheters and enteral feeding tubes. Separate tables list emergency kit supplies for each.
The report outlines seven key needs to promote success
for the child:
• minimize time away from classroom learning;
• establish a designated location for care;
• provide ongoing monitoring;
• pay special attention and plan for physical education,
recess and extracurricular activities;
• offer emotional and social support;
• provide proper storage for equipment and nutrition solu-
• educate classmates about the child’s needs.
Resources aim to prevent pediatric sepsis