Abstract: Psychiatric disorders are becoming more frequently diagnosed within the pediatric primary care setting. Despite increased diagnosis within primary care, only a minority of patients receive further psychiatric or specialty care. The integrated/collaborative care treatment model was designed to improve access within primary care. The purpose of this review is to identify randomized controlled trials and quasi-experimental studies that have investigated whether increased access improves treatment engagement, satisfaction, and improved mental health outcomes. Six studies met inclusion criteria. Studies reviewed indicated increased access to behavioral health treatment through use of the integrated/collaborative care model and improved mental health outcomes. Recommendations for screening and treatment are provided. Limitations of the reviewed studies include lack of generalizability to urban populations, minority youth, and youth younger than 4 years of age. Practice recommendations to address these limitations are identified.

Abstract: Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.

Abstract: Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These findings have implementation implications for programs aiming to address social needs in practice. Less than half of households reported successful referrals, which suggests the need for additional research and an opportunity for further program optimization.

Abstract: Excessive daytime sleepiness (EDS), a common presenting symptom among children and adolescents, is caused by a wide range of sleep disorders and other conditions, and it may impair health, development, and daily function.1-3 Studies have reported rates of EDS due to various etiologies ranging from 10% to 20% in prepubertal children4-8 and 16% to 47% in adolescents.7,9,10 Sleep problems that can cause EDS are present in an estimated 25% to 40% of children and adolescents,11 encompassing behavioral, neurologic, and respiratory disorders. Other conditions affecting sleep (eg, chronic pain, nocturnal seizures, and prescription and/or illicit drugs) are important contributors in some children, as reviewed elsewhere.2,12-17 Untreated pediatric sleep problems and associated EDS may lead to behavioral problems, mood disturbances, depression, dysregulation of affect/emotion, impairments in neurocognitive function, increased risk for alcohol and drug use in teenagers, declining academic performance, and safety concerns.18-20 Long-term chronic sleep loss, which results in EDS, adversely affects physiologic systems such as carbohydrate metabolism and endocrine function, potentially increasing risk for type 2 diabetes and cardiovascular dysfunction, with associated hypertension/risk of atherosclerosis and proinflammatory response.18 Epidemiologic data also suggest that short sleep duration is associated with an increased risk of obesity (a significant health problem itself) in children and adolescents.21 Other risks associated with chronic sleep loss in children and adolescents include increased unintentional injuries,22 sports-related injuries,23 and automobile crashes.22,24 Specific sleep disorders frequently accompanied by EDS have also been associated with health-related adverse effects; for example, obstructive sleep apnea (OSA) in children and adolescents has been correlated in multiple studies with growth failure and insulin resistance, as well as hypertension and inflammatory changes in systemic and central nervous system vasculature.25,26 Children and adolescents with EDS are also more prone to being bullied, to being regarded as “lazy,” “inattentive,” or “unmotivated,” and to having low self-esteem.2,12 Excessive daytime sleepiness in children and adolescents is underreported by parents and underdiagnosed by physicians, possibly due to lack of recognition.3,27 Externalizing symptoms such as hyperactivity and oppositional behavior in children may be attributable to EDS, and children may not recognize or be able to verbalize the internal state of “sleepiness.”3 Thus, children and adolescents with EDS often present to primary care pediatricians when parents become concerned about behavioral, mood, and academic issues that they may not attribute to underlying sleep problems. Given the high prevalence and potential health implications, prompt detection, diagnosis, and management of EDS is an essential component of primary pediatric care.

Abstract: This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.

Abstract: Project ECHO (Extension for Community Healthcare Outcomes) is a teleconsultation model for enhancing the treatment of underserved patients in primary care. Previous behavioral health (BH) adaptations of Project ECHO have primarily focused on adults or specific diagnoses and have relied on self-reported outcomes. The purpose of this pilot was to adapt Project ECHO to support pediatric primary care providers in addressing common BH needs and to conduct an initial evaluation of its effectiveness. Overall, participants reported high levels of satisfaction and a statistically significant improvement in their overall knowledge and skills (P = 0.001). Participation was also associated with a reduction in the use of psychotropic polypharmacy. This pilot adds to a growing body of literature suggesting that Project ECHO is a promising workforce development approach to build competencies for the management of BH issues in primary care.

Abstract: Adolescents with diabetes are at increased risk for depression and anxiety, which when untreated negatively affects diabetes control. During a 6-month period, the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) screening tool was utilized. Those with a positive screen then completed the Patient Health Questionnaire for Adolescents (PHQ-A) and the Generalized Anxiety Disorder 7-item (GAD-7) scale. In this article, we report on the correlations in outcomes between the PHQ-4 and the PHQ-A and GAD-7 and its clinical utility for determining the need for standard versus acute behavioral health care. Over 6 months, 77 patients aged 10 to 18 years screened positive on the PHQ-4. Thirty-two patients had positive screening with the PHQ-A and/or the GAD-7. Thoughts of self-harm were reported by 13 (40%), with 1 experiencing current/active symptoms. The PHQ-4 as a screening tool was able to identify adolescents with symptoms of depression and/or anxiety who would benefit from further evaluation by a behavioral health provider.

Abstract: Attention-deficit hyperactivity disorder (ADHD) is associated with reduced school performance. To determine which ADHD symptoms and subtypes have the strongest association, we used type and frequency of symptoms on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA) to create symptom scores for inattention and hyperactivity-impulsivity and define subtypes (ADHD-Inattentive [ADHD-I], ADHD-Hyperactive-Impulsive, ADHD-Combined [ADHD-C]). Regression methods were used to examine associations between symptoms and subtype and a composite measure of school performance. Children with ADHD-C and ADHD-I had higher adjusted odds of having reduced overall school performance (ADHD-C = 5.8, 95% confidence interval [CI] = 3.1-10.9; ADHD-I = 5.5, 95% CI = 3.1-10.1) compared with children without ADHD. All inattentive symptoms were significantly related to reduced school performance in reading, writing, and handwriting, while 6 of 9 symptoms were significantly associated in mathematics. Children with ADHD-I were significantly more likely than children with other ADHD subtypes to receive a school-based Individualized Education Program or 504 Plan. ADHD-I symptoms may be broadly linked to reduced school performance.

Abstract: The novel coronavirus, SARS-CoV-2, has caused a global outbreak of coronavirus disease 2019 (COVID19), which began in Wuhan, Hubei Province, China, in December 2019, and it has rapidly spread to involve 170 countries and regions with 304 528 confirmed cases and 12 973 deaths as of March 21, 2020.1 The spectrum of clinical presentation is varied and nonspecific in adults ranging from mild flu-like illness to florid respiratory failure including acute respiratory distress syndrome.2 Recent data out of China have evaluated the epidemiology of children with COVID-19 and found that children of all ages are affected by the virus and tend to have a milder course of disease compared with adults, though there remains subpopulations of pediatric patients at higher risk for significant disease.2-4 Recognition of disease in this patient population remains critical in both management of disease and for quarantine to limit further transmission. This case report focuses on a 2-week-old male infant who presented to the pediatric emergency department with fever and fussiness. Globally, China has published 2 case reports of neonatal COVID-19 infection, and to the best of our knowledge, there has been no published case reports in the United States of COVID-19 in a patient as young as 2 weeks.5

Abstract: The number of children with confirmed coronavirus disease 2019 (COVID-19) is increasing substantially due to the lack of special prevention and control measures, especially in younger age groups.1 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new type of coronavirus. No specific therapies have been shown effective to date.2 Treatment is mainly directed at symptomatic relief and includes antipyretics, antitussives, mucolytics, and anti-diarrheal therapy. If the disease does not resolve, then antiviral and antibiotic therapy may be used. According to the guidelines for treatment of SARS-CoV-2 infection (Trial Version 7),3 patients can be discharged if they meet all the criteria for clinical cure. A small proportion of adults experience recurrence in a positive test for SARS-CoV-2 during convalescence,4-6 but there are currently no known specific clinical characteristics to predict the reactivation of SARS-CoV-2.6 To the best of our knowledge, there are no published studies on the reactivation of SARS-CoV-2 in children. The aim of this study was to determine the clinical features of children with SARS-CoV-2 reactivation after hospital discharge.

Abstract: This study investigated children <18 years old treated for burns in United States (US) emergency departments from 1990 to 2014 using data from the National Electronic Injury Surveillance System. Th...

Abstract: We examined the association between sleep quality and quality of life (QOL) among uninjured high school athletes. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 questionnaire. One hundred ten athletes reported poor sleep quality (mean PSQI: 6.6 ± 2.0; mean age: 15.3 ± 1.1; 62% female); 162 athletes reported good sleep quality (mean PSQI: 2.3 ± 1.3; mean age: 15.1 ± 1.7; 33% female). After adjusting for sex and age, worse sleep quality was associated with higher physical function/mobility (β = 0.034; 95% confidence interval [CI] = 0.007-0.060; P = .01), anxiety (β= 0.391; 95% CI = 0.263-0.520; P < .001), depressive symptom (β = 0.456; 95% CI = 0.346-0.565; P < .001), fatigue (β = 0.537; 95% CI = 0.438-0.636; P < .001), pain interference (β = 0.247; 95% CI = 0.119-0.375; P < .001), and pain intensity (β = 0.103; 95% CI = 0.029-0.177; P = .006) ratings. Poor self-reported sleep quality among adolescent athletes was associated with worse QOL ratings. Clinicians should consider assessing sleep hygiene to provide guidance on issues pertaining to reduced QOL.

Abstract: American Academy of Pediatrics (AAP) guidelines for children with Down syndrome (DS) include assessment for celiac disease (CD), although data to support this recommendation have been inconsistent. We determined the incidence of CD among children with DS in a population-based birth cohort of children born from 1976 to 2000 in Olmsted County, Minnesota. Individuals with karyotype-confirmed DS and CD (using diagnosis codes, positive serology, and duodenal biopsies) were identified. The incidence of CD in DS was compared with the published incidence of CD for Olmsted County residents (17.4 [95% confidence interval = 15.2-19.6] per 100 000 person-years). Among 45 individuals with DS from the birth cohort, 3 (6.7%) were identified with positive celiac serology and confirmatory biopsies at ages 9, 12, and 23 years, for an incidence of 325 per 100 000 person-years. Thus, individuals with DS have more than 18 times the incidence rate of CD compared with the general population, supporting the AAP guidelines.

Abstract: Novel coronavirus 2019 causing coronavirus disease (COVID-19) was announced as a pandemic by the World Health Organization (WHO) on March 11, 2020.1 The virus has been known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has infected >200 000 patients worldwide, out of which >8000 have died.2 In the United States, >10 000 patients have been infected with SARS-CoV-2 causing >150 deaths as of March 19, 2020.3 Even though elderly population with comorbidities are at higher risk of morbidity and mortality, the pediatric population has been relatively spared in showing severe manifestations, complications, or mortality.4 In this commentary, we have compiled available evidence in the pediatric population based on published literature.

Abstract: Background. Testicular torsion is a common surgical emergency in children that requires a high index of suspicion, early diagnosis, and exploration. Most children present early to their primary pediatricians or physicians. The aim of this retrospective study is to determine the surgical outcome of testicular torsion with early as well as delayed presentation or referral at our pediatric surgical unit. Methods. Records of 50 patients who presented with testicular torsion at our pediatric surgical unit over the span of 10 years (2007-2017) were reviewed retrospectively. The duration and characteristics of symptoms, initial consultation with primary care health professional, time duration between the initial consultation and referral to a tertiary care center, clinical findings prior to surgery, and operative findings were noted. Results. Fifty patients were in the age group ranging from 38 days to 18 years. All the patients consulted the primary care health professionals within 3 to 6 hours after the onset of testicular pain. The patients presented to our hospital within the range of 3.5 hours to 10 days of onset of initial symptoms. Out of 50 patients who presented to our hospital with torsion testis, 45 (90%) patients underwent orchidectomy as the testicle was gangrenous and 5 patients underwent orchiopexy as the testicle was viable. Conclusion. The risk of testicular loss is very high if there is delay in the initial diagnosis of testicular torsion. Greater effort in educating the primary health care professionals may reduce this delay. Primary objective of treating the acute scrotum should be prevention of testicular loss than treating symptoms.

Abstract: Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC. Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care. As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.

Abstract: Objective. Phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. We reviewed the current literature to determine whether home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Method. PubMed, Scopus, Embase, Cochrane library, CBM, CNKI, and Wanfang Data were searched to collect the comparative study of home-based phototherapy versus hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. All studies were found to be of low risk based on Cochrane Collaborative Risk of Bias Tool. Data were statistically extracted and evaluated by RevMan 5.3 software. Result. A total of 259 neonates were included in the meta-analysis. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference = 0.32, 95% confidence interval = -0.22 to 0.86, P = .04); however, there was no significant difference in duration of phototherapy (standard mean difference = 0.59, 95% confidence interval = 0.28 to 0.90, P = .06) in the 2 groups. Conclusion. Home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy is an effective, feasible, safe, and alternative to hospital-based phototherapy for neonatal hyperbilirubinemia.

Abstract: Objective. This study assessed safety culture and staff communication with patients with limited English proficiency (LEP) to identify system-level approaches to increasing interpreter use and redu...

Abstract: Introduction. Celiac disease, an autoimmune enteropathy, occurs in susceptible individuals and is treatable with a gluten-free diet. These may not be supplemented with vitamins. Objective. To assess the nutritional health of children who have biopsy-proven celiac disease. Methods. Charts were reviewed between July 1, 2007, and June 30, 2017. Results. A total of 252 children ages 0 to 21 years had biopsy-proven celiac disease, mean age 11 ± 4.1 years. Body mass index Z-score was 0.2 ± 1.2 at diagnosis. Except for vitamin D, few had deficiencies at diagnosis. At 1-year follow-up, there was no significant change in anthropomorphics or vitamin status. Adherence to follow-up was poor; at 5 years after diagnosis, 39% adhered to follow-up. Conclusion. Despite a rigorous, proactive protocol for contacting and following children with celiac disease, adherence to follow-up was poor. New strategies, such as follow-up through the primary care provider, are needed.

Abstract: Using data from 600 adolescents (14-17 years old) from the 2015 National Survey of Sexual Health and Behavior, we examined the prevalence and demographic correlates of adolescents’ romantic activit...

Abstract: Our objective was to evaluate the risk of short stature in children with attention-deficit/hyperactivity disorder (ADHD) and the effect of ADHD and its treatment on height-for-age z score (HAZ) and body mass index-for-age z score (BMIZ) in early childhood. We evaluated 7603 children from the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 and found that children with ADHD had lower HAZ at second and fourth grades and lower BMIZ at K to fourth grade. Children with ADHD at fourth grade had almost 4 times higher odds of short stature. Children with ADHD at K grew at a slower rate from K to fourth grade (difference in ΔHAZ = 0.23, 95% confidence interval = 0.04-0.42) and had less gain in BMI (difference in ΔBMIZ = 0.16, 95% confidence interval = 0.03-0.29). Longer duration of ADHD medication use was associated with lower HAZ at fourth grade and slower growth from K to fourth grade. These data may assist pediatricians in considering risk of poor growth in children with ADHD.

Abstract: The American Academy of Pediatrics recommends pediatric providers routinely screen for, assess, and treat substance use and substance use disorders among adolescents, a process called “Screening, B...

Abstract: A kind of pneumonia caused by 2019 novel coronavirus (SARS-CoV-2) first reported to emerge in Huanan Seafood Wholesale Market of Wuhan, Hubei Province, in December 2019; the disease caused by SARS-CoV-2 was named coronavirus disease (COVID-19) by the World Health Organization. It was classified as a class B infectious disease and was managed as a class A infectious disease in China in January 2020, as COVID-19 is highly contagious with a certain mortality rate.1 China has implemented infection control measures strictly, isolated the confirmed and suspected cases, and treated them according to international standards, constantly updated the diagnosis and treatment process, and carried out public education.2 So far, more than 200 000 cases of COVID-19 have been confirmed, and more than 8000 people have lost their lives, and it has been spreading in many countries now.3,4 Nevertheless, details of children, younger than age 1 year, who suffered from severe pneumonia induced by SARS-CoV-2 infection and respiratory syncytial virus (RSV) has rarely been reported.5 Thus, a patient with COVID-19 and also infected RSV, an extremely rare case, has been report in this study.

Abstract: Infections is a common complication of nephrotic syndrome (NS). Our objective was to evaluate the frequency and risk factors for serious bacterial infections (SBI) in febrile children with NS. We reviewed 239 admissions of 107 children with NS who were admitted with fever to a tertiary hospital in Israel, during 1995 to 2016. SBI was diagnosed in 35 admissions (14.6%), most commonly with pneumonia (n = 12), bacteremia/sepsis (n = 8), and urinary tract infection (n = 6). Patients with SBI were more likely to be female (60.0% vs 36.3%, P = .008) and have nephrotic-range proteinuria (71.4% vs 43.6%, P = .010) and edema (62.9% vs 27.0%, P < .001) on admission. No differences were found between the SBI and non-SBI groups in the clinical and histopathological type of NS, immunosuppressive treatment, rate of pneumococcal vaccination, and prophylactic antibiotics. In summary, 1 of 7 children had SBI, most commonly pneumonia, bacteremia/sepsis, and urinary tract infection. Active nephrosis was associated with an increased risk for SBI.

Abstract: Pediatricians caring for patients with child abuse or neglect (CABN) may experience secondary traumatic stress (STS) from traumatized patients, or burnout (BO) from workplace stress. This may be buffered by compassion satisfaction (CS), positive meaning from one's work. For this study, STS, BO, and CS specific to a pediatrician's care of CABN were assessed for residents, hospitalists, intensivists, and outpatient physicians. Using the Professional Quality of Life Scale modified for CABN experiences, participants (n = 62) had a mean STS score at the 84th percentile, a mean BO score at the 66th percentile, and a mean CS score at the 17th percentile. Reporting one CABN patient as most emotionally impactful predicted STS, caring for all types of CABN predicted BO, and perceived knowledge no longer predicted CS when adjusting for the experience of mandated reporting or CABN fatality. These results highlight the need to support pediatricians involved with CABN.

Abstract: Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed "extensively resistant typhi," has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

Abstract: While influenza vaccination in the prior year is a strong predictor of subsequent vaccination, many families do not have static vaccination patterns. This study examined factors guiding influenza vaccination decisions among parents whose children sporadically received the influenza vaccination (flu-floppers). We administered surveys to 141 flu-flopper families. Surveys included 21 factors associated with vaccine decision making. A conceptual framework of "passive" and "active" decision making was used to assess parental motivators behind vaccine decisions. The most common reason for vaccinating was a desire to prevent influenza (45%). The most common reason for not vaccinating was a belief that influenza vaccination is not effective (29%). Most parents (88%) reported an active reason in years when their child was vaccinated, while only 43% reported an active reason when their child was not vaccinated (P < .00001). These findings may guide efforts to increase influenza vaccination rates in children most amenable to vaccination.

Abstract: Childhood exposure to intimate partner violence (IPV) is a public health issue. Approximately 1 in 6 US youth will be exposed to IPV during their childhood. Exposure to IPV may occur through direct witnessing of a wide array of coercive behaviors used to maintain power and control over an intimate partner (Figure 1), as well as witnessing outcomes of abuse, such as parental depression, physical injury, or destruction of household materials. This exposure results in chronic activation of the stress response system and subsequent maladaptive changes that lead to increased risk for myriad negative outcomes across the life course. These outcomes include poor physical, mental, and developmental health, and increased risk for child maltreatment. The American Academy of Pediatrics recognizes the negative impact of childhood IPV exposure and the unique opportunities pediatric health care providers have to address IPV. Most caregivers find IPV screening and intervention in pediatric health care settings acceptable. Intervention by others and the impact of IPV on children are often motivators to seek help for IPV. Additionally, mothers experiencing IPV may seek care more often for their children than themselves, providing opportunities to address IPV that might not be available to adult care providers.

Abstract: Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers' antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers' CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non-guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, P < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician's selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.