The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.

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The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.

Few physicians in the United States receive formal education related to principles of infant care in Islamic families. Breastfeeding has a religious basis in Islam and it is recommended that the mother suckle her offspring for 2 years if possible. Weaning from the breast before that period is allowed if mutually decided on by both parents. The infant's father has an obligation to support his wife through any circumstances that may affect breastfeeding and, in case of divorce, provide shelter and financial support to the mother-infant dyad for as long as breastfeeding continues. By showing understanding and respect of Islamic beliefs related to infant feeding, clinicians can help support healthy early feeding of Muslim infants.

In our pilot, there was no significant difference in parent satisfaction between consultations for childhood obesity delivered face to face and by telemedicine. Therefore, preliminary evidence suggests that childhood obesity care delivered by telemedicine can improve access to quality patient-centered care in underserved rural areas. An important limitation is our sample size, which was not large enough to determine whether satisfaction in the telemedicine group was greater than in the face-to-face group.