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Importance: In 2021, the American Academy of Pediatrics published a policy statement seeking to create a paradigm shift away from a focus on childhood toxic stress and toward the emphasis on early relational health (ERH) as a buffer for childhood adversity and promoter of life-course resilience. A comprehensive appraisal of the efficacy of contemporary parent/caregiver-child interventions in — primarily — improving ERH, and — secondarily — enhancing child wellbeing and neurodevelopment is needed to guide widespread implementation and policy. Objective: Determine the effectiveness of contemporary early dyadic parent/caregiver-infant interventions on ERH, child socio-emotional functioning and development, and parent/caregiver mental health. Data Sources: PubMed, Medline, Cinhal, ERIC, and PsycInfo were searched on April 28, 2022. Additional sources: clinical trial registries (clinicaltrials.gov, ISRCTN Registry, EU Clinical Trials Register, Australian New Zealand Clinical Trials Registry), contacting authors of unpublished/ongoing studies, backward/forward reference-searching. Study Selection: Studies targeting parent/caregiver-infant dyads and evaluating effectiveness of a dyadic intervention were eligible. Study selection was performed in duplicate, using Covidence. Data Extraction and Synthesis: Cochrane methodological guidance presented per PRISMA guidelines. Data extraction and risk of bias assessment were completed in duplicate with consensuses by first author. Data were pooled using inverse-variance random effects models. Main Outcomes and Measures: The primary outcome domain was ERH. Secondary outcome domains were child socio-emotional functioning and development, and parent/caregiver mental health, and were only considered in studies where at least one ERH outcome was also measured. The association between dose of intervention and effect estimates was explored. Results: 93 studies (14,993 parent/caregiver-infant dyads) met inclusion criteria. Based on very low to moderate quality of evidence, we found significant non-dose-dependent intervention effects on several measures of ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions, and a significant effect on parent/caregiver anxiety, but no significant effects on other child outcomes. Conclusion: Current evidence does not support the notion that promoting ERH through early dyadic interventions ensures optimal child development, despite effectively promoting ERH outcomes. Given the lack of an association with dose of intervention, the field is ripe for novel, innovative, cost-effective, potent ERH intervention strategies that effectively and equitably improve meaningful long-term child outcomes.

RATIONALE: Despite increasing prevalence rates, anaphylaxis is underdiagnosed and undertreated by physicians, suggesting a gap in medical education. We hypothesized that the early introduction of anaphylaxis education into the medical school curriculum would improve students' knowledge of anaphylaxis diagnosis and management. METHODS: Third-year medical students were studied prospectively during their pediatric clerkship at a children's hospital. Students were randomly assigned to group A (didactic lecture plus simulation laboratory) or group B (didactic lecture only). All students completed a pre-test to assess baseline knowledge of anaphylaxis. All students then received a lecture on anaphylaxis, followed by a post-test. Group A then participated in a scripted anaphylaxis scenario in the Simulation Laboratory. All subjects completed a long-term follow-up test and satisfaction questionnaire 8-12 weeks later. RESULTS: A total of 87 students completed the study. Mean test scores improved significantly for both groups from pre-test (Group A: 5.93 6 1.70, Group B 5.86 6 1.44) to post-test (Group A 9.16 6 1.00, Group B 9.24 6 0.98), p <.01. However, long-term follow-up scores did not differ between Groups A (7.00 6 1.57) and B (6.93 6 1.76), p5.85. Most students reported a positive learning experience (97.8% of Group A and 76.2% of Group B). CONCLUSIONS: Although students strongly support simulation training for anaphylaxis education, the addition of a simulation module to didactic lecture does not improve long-term retention of anaphylaxis knowledge. Future studies should focus on other educational modalities that will enhance medical student knowledge of this potentially fatal condition.

Globus hystericus, also known as globus pharyngeus or globus sensation, is characterized by the physical sensation of a mass in one’s throat. Globus sensation is more common in adults and reported more rarely in children. Adult patients with globus sensation score higher on neuroticism, introversion, anxiety, and depression. However, not all patients with globus sensation have psychiatric abnormalities. Thus, it is important to share an atypical presentation in children and highlight the necessity of ruling out other organic causes. The present case study elucidates the process of ruling out medical etiologies of globus sensation in a young girl with anxiety and food aversion. We provide a review discussion of the differential diagnoses, both medical and psychiatric, of globus sensation in the pediatric population reported in past literature. The case study and review of pediatric globus sensation shows that the symptom can be associated with a wide array of psychological and medical diagnoses. The medical differential diagnoses of globus sensation include the gastroenteric system, laryngeal system, cardiovascular system, and nervous system. We encourage critical analysis of other potential diagnoses, given each patient’s unique history and physical presentation.