ABSTRACT. Objective. Breastfeeding is the preferred nutrition for infants, but many pediatricians report inadequate training to advise mothers who breastfeed. This study was designed to examine the effect of an educational intervention on pediatric residents' knowledge about breastfeeding, their confidence in addressing lactation issues, and their management skills during clinical encounters with breastfeeding mothers.Design. An interactive multimedia curricular intervention was designed for pediatric residents to increase their knowledge about common lactation issues. The residents completed questionnaires before and after the intervention to measure knowledge and confidence. Resident behaviors in the clinical setting were measured before and after the intervention using telephone surveys of breastfeeding mothers after a clinic visit with a pediatric resident.Results. Forty-nine pediatric residents participated in the study. Mean knowledge scores increased from 69% before the intervention to 80% after the intervention. Significant increases in knowledge included advising mothers about low milk supply, mastitis, abscess, or using medication, and in recognizing the benefit of the decreased risk of maternal cancer. Management skills with breastfeeding mothers and infants in the clinical setting improved significantly. Before the intervention residents performed an acceptable number of behaviors 22% of the time, while after the intervention their performance was acceptable 65% of the time. Particular behaviors that showed significant improvement after the intervention included discussing signs of breastfeeding adequacy with the mother and correct management of lactation problems.Conclusions. These results indicate that not only breastfeeding knowledge and confidence, but most importantly clinical behaviors of pediatric residents can be enhanced through innovative educational opportunities. Appropriate counseling for breastfeeding mothers by pediatricians might contribute to an increase in the duration of breastfeeding. Pediatrics 2002;110(5). URL: http://www.pediatrics.org/cgi/content/full/110/5/e59; breastfeeding, education, medical, internship and residency, lactation. Breastfeeding is preferred for all infants, and exclusive breastfeeding of infants is recommended for the first 6 months after birth. 1 The benefits of breastfeeding to both infant and mother are well known and include superior nutritional content of human breast milk, enhanced immunologic status of the newborn, strengthening of the infantmother dyad, delayed return of ovulation, and economic savings. 2 The Healthy People 2010 Objectives include goals of having 75% of mothers breastfeed their infants in the early postpartum period, and 50% continuing to breastfeed at least 6 months. 3 Largescale national surveys indicate increasing rates of initiation and continuation of breastfeeding, but current rates still fall significantly short of year 2010 goals, with lower rates seen in mothers who are black, young, less educated, in the lowest income group...

Children younger than 2 years experienced lower first-attempt successful PIV placement and took longer. The overall success rate was similar to prior reports; these data are the first to show differential PIV success by patient age.

The insertion of peripheral IV catheters in an inpatient setting can be time intensive and requires significant skill. Our study suggests that resource utilization may improve when nurses and personnel proficient in starting peripheral IV catheters are used when the initial nurse has failed to obtain IV access. This systems improvement should result in shortened time to administration of parenteral therapies, positively improving outcomes and lessening length of stay, as well as improving patient/family satisfaction due to reduced perceptions of pain.

Placement of peripheral pediatric intravenous (IV) catheters in infants and children is difficult, even in skilled hands. This large, 2-institution prospective study used real-time independent observations to describe the effect of nurse experience and competence on the length of time and the number of attempts to establish a successful IV placement in the hospitalized child. Data from a convenience sample of 592 evaluable patients and 1135 venipunctures showed that successful IV placements required an average of 2 venipunctures over 28 minutes. Although nurse experience and self-rated competence were correlated with attaining a successful IV placement, time of day, predicted difficulty of the venipuncture, and cooperativeness of the child appeared to be better predictors of success.