Immunization recall systems have been found effective in increasing immunization rates in younger children and adults; however, there have been only a few studies in adolescents and they have produced mixed results.
In this randomized controlled trial, immunization rates were significantly higher 4 weeks after a recall intervention in which both the adolescent’s parents and the adolescent were contacted, but this effect did not persist 1 year after the intervention. (Read the full article)
Many children are vaccinated against measles with a delay. This may influence effective measles vaccine coverage even in countries with high overall immunization levels. Official vaccine coverage statistics do not usually report on the impact of timeliness of measles vaccination.
Delayed measles vaccination results in 48.6% effective coverage in children aged 6 months to 2 years when 84.5% of 25-month-olds are up-to-date for 1 measles vaccination. Analyzing patterns of measles vaccination could help to address low coverage in infants and toddlers. (Read the full article)
There is evidence from both developed and developing countries that antiretroviral treatment significantly reduces mortality in HIV-infected children. However, in sub-Saharan Africa, numerous health system, financial, and human resource obstacles make delivering quality pediatric HIV care a challenge.
We describe the experience of the Baylor International Pediatrics AIDS Initiative in Malawi, Lesotho, and Swaziland. Despite challenges delivering pediatric treatment in these countries, mortality and clinical outcomes approaching those from developed countries are feasible. (Read the full article)
Policies that govern nutrition standards of foods and beverages sold outside of federal meal programs ("competitive foods") have been associated with adolescent weight status in a small number of cross-sectional studies and pre-post analyses in individual states.
This longitudinal analysis of 6300 students in 40 states provides evidence that state competitive food laws are associated with lower within-student BMI change if laws contain strong language with specific standards and are consistent across grade levels. (Read the full article)
Cholestasis predisposes to the development of fat-soluble vitamin (FSV) deficiency. D-α tocopheryl polyethylene glycol-1000 succinate and coadministered FSVs are absorbed in spite of cholestasis.
Infants with biliary atresia with total bilirubin >2 mg/dL are at risk for fat-soluble vitamin (FSV) deficiency. A multivitamin preparation containing d-α tocopheryl polyethylene glycol-1000 succinate alone is not effective in treating biochemical FSV insufficiency in cholestatic infants. (Read the full article)
Computerized provider order entry (CPOE) has been recognized to enhance the efficiency, safety, and quality of medical work. Yet vendors and organizations have not determined best practices for customizations, resulting in systems that have poor usability and unintended consequences of use.
This study demonstrated that systematically developed order sets reduce cognitive workload and order variation in the context of improved system usability and guideline adherence. The concept of cognitive workload reduction is novel in the setting of computer order entry. (Read the full article)
Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.
This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)
Ideal empirical antibiotic choices are based on local susceptibility data. These choices are important for ensuring positive patient outcomes, but pediatric-specific data may not be available.
Antibiotic susceptibilities differ by age group within a tertiary-care hospital. Knowing these differences, pediatricians chose empirical antibiotic therapy more likely to be successful. Children with infectious diseases would benefit from reporting of pediatric-specific susceptibility results. (Read the full article)
Loud snoring, which spikes at ~2 to 3 years of age, has been associated with behavior problems in school-aged children in cross-sectional studies, but no longitudinal studies have quantified predictors and the behavioral impact of persistent snoring in preschool-aged children.
Persistent loud snoring, which occurs in 9% of children 2 to 3 years of age, is linked with behavior problems. Higher socioeconomic status and a history of breastfeeding were associated with lower rates of transient and persistent snoring in young children. (Read the full article)
Bronchiolitis is one of the most common infectious respiratory conditions of early childhood, and most children have a mild clinical course. Unfortunately, the small subgroup of children requiring continuous positive airway pressure and/or intubation remains ill-defined.
In children with bronchiolitis, we found several demographic, historical, and clinical factors that predicted the need for mechanical respiratory support including in utero smoke exposure. We also found a novel subgroup of children with bronchiolitis who have a rapid respiratory decline. (Read the full article)
Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children.
This study demonstrates that a healthy media use intervention can improve child sleep outcomes and adds evidence that the relationship between media and sleep in preschool-aged children is indeed causal in nature. (Read the full article)
Honey is recommended as a cough medication by the World Health Organization. To date, the efficacy of this treatment has been shown in 2 studies: one tested only buckwheat honey and the other study was not blinded.
In a randomized controlled trial, we compared 3 types of honey versus placebo as a treatment of upper respiratory tract infection–associated cough. These types of honey were superior to placebo in alleviating cough. (Read the full article)
Vitamin D is a pleiotropic hormone important for proper functioning of multiple organs. Adult critical care studies have suggested vitamin D as a modifiable risk factor. No studies have investigated the prevalence, risk factors, or role in pediatric critical illness.
This study provides evidence that the majority of critically ill children have vitamin D deficiency at the time of PICU admission, and that lower levels are associated with hypocalcemia, catecholamine administration, significant fluid bolus requirements, and longer PICU admissions. (Read the full article)
Neonatal sepsis is an important cause of under-5 childhood mortality. Infants born to HIV-infected mothers are at increased risk of morbidity and mortality, even if not having acquired HIV. This association needs further study during the neonatal period.
Maternal HIV infection was associated with increased vaginal colonization by Escherichia ecoli but not group B Streptococcus. Neonates born to HIV-infected mothers were only at increased risk of sepsis if they had acquired HIV-infection, but not if HIV-uninfected. (Read the full article)
Childhood obesity is already prevalent by preschool age, particularly among Latinos. Parents have tremendous influence on factors that contribute to childhood obesity (eg, diet, physical activity); thus, family plays a crucial role in pediatric obesity prevention.
This randomized controlled trial examined the effect of a behavioral intervention involving Latino-American parent–preschool-aged child dyads. The intervention resulted in reductions in absolute BMI across the 3-month study period, with patterns suggesting the largest effect for obese children. (Read the full article)
Vitamin D is essential for bone health and for cardiovascular and immune function. In critically ill adults, vitamin D deficiency is common and associated with sepsis and with higher critical illness severity. The influence on pediatric critical illness is unclear.
We found a high prevalence of vitamin D deficiency in critically ill children, which was associated with higher critical illness severity. Vitamin D deficiency was less common in younger patients, in non-Hispanic white patients, in patients admitted over the summer, and in children taking supplemental vitamin D, with increasing amounts being more protective. (Read the full article)
Since the introduction of effective vaccines in the United States, the incidence of invasive Haemophilus influenzae type b (Hib) disease in children aged <5 years has decreased by 99%. In 2007, in response to limited vaccine supply, Hib booster doses were deferred for 18 months.
This review found no significant change in the incidence of invasive Hib disease in the United States during the booster dose deferral period, suggesting that booster dose deferral is a reasonable approach to Hib vaccine shortages in the short-term. (Read the full article)
To date, 4 small to moderate sized studies have revealed conflicting results on the clinically important question whether thrombocytopenia contributes to persistent patent ductus arteriosus (PDA) in very immature, preterm infants.
Thrombocytopenia in the first 24 hours after birth was not associated with the incidence of PDA at postnatal day of life 4 to 5 in a large cohort of preterm infants with <1500 g birth weight. Platelet dysfunction, rather than platelet number, might play a role in ductus arteriosus patency. (Read the full article)
Children with obstructive sleep apnea (OSA) are usually treated by surgical removal of their upper airway lymphadenoid tissue. Recently, medications were offered to patients with nonsevere OSA. Montelukast, for this indication, had never been studied in a randomized controlled manner.
Montelukast effectively reduced polysomnographic findings, symptoms, and the size of the adenoidal tissue in children with nonsevere OSA. The findings support the potential of a leukotriene modifier as a novel, safe, noninvasive alternative for children with mild to moderate OSA. (Read the full article)
Food insecurity has been linked to childhood obesity in a number of studies. Few studies have explored potential pathways through which food insecurity is related to child weight, especially in low-income families with young infants.
We found that food insecurity was related to maternal controlling feeding styles and concerns about the infants’ future weight. Early obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure. (Read the full article)
The American Academy of Pediatrics prioritized detection of mental illness in children presenting to emergency departments (ED) by using standardized clinical tools. Only a minority of ED physicians indicate that they use evidence-based screening methods to assess mental health concerns.
This study presents the psychometrics of the HEADS ED (home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources), a brief, standardized screening tool for pediatric EDs. This tool ensures key information is obtained for decision-making, determining acuity level, and areas of need. (Read the full article)
Percentile charts for birth weight are used to assess the somatic development of neonates (small, appropriate, or large for gestational age).
A systematic error was identified in the majority of birth weight percentile charts. As a consequence, small for gestational age rates are overestimated and large for gestational age rates are underestimated; ~5% of neonates are misclassified. (Read the full article)
Because most childhood tuberculosis cases are sputum smear-negative, diagnosis relies largely upon clinical presentation, tuberculin skin testing, and chest radiograph. Diagnostic limitations contribute to treatment delays and high mortality. However, childhood tuberculosis (TB) mortality risk factors are not well documented.
This study demonstrates that false-negative TST is common in children with active TB and is associated with increased risk of death. A negative TST should not delay anti-TB therapy. Improved diagnostic modalities are urgently needed in resource-limited settings. (Read the full article)
Infantile hemangiomas have a period of rapid growth in early infancy. Most hemangioma growth is completed by 5 months of age, but the majority of patients are not seen by a specialist until after the growth phase is complete.
The most rapid hemangioma growth is between 1 and 2 months of life, much earlier than previously believed. Patients with high-risk hemangiomas should be followed closely, and treatment initiation should be considered before or during the most rapid growth phase. (Read the full article)
Children’s mastery of fundamental movement skills is correlated with a number of health benefits, including higher levels of physical activity, cardiorespiratory fitness, perceived scholastic and athletic competence, and lower levels of overweight.
This is the first study to examine the associations between low skill competence (a new and novel way to report motor skills) and a range of health-related and sociodemographic factors in a large representative sample of children and youth. (Read the full article)
Trisomy 13 and 18 are conditions with 1-year survival rates of less than 10% and have traditionally been treated with palliative care. There are increasing reports of ethical dilemmas caused by parental requests for clinical interventions.
Parents who belong to social networks report an enriching family experience and describe surviving children as happy. Many of these parents describe challenging encounters with health care providers. (Read the full article)
Children without any underlying medical condition who walk on their toes are referred to as idiopathic toe-walkers. The prevalence and early course of idiopathic toe-walking are unknown.
This study establishes the prevalence and early spontaneous course of idiopathic toe-walking in a large, well-defined cohort of 5.5-year-old children. (Read the full article)
Many drugs are not approved for use in pediatric patients and there is limited evidence on their safety and efficacy in children. Furthermore, there is concern that the quality of pediatric trials is inferior compared with adult trials.
For conditions with a high disease burden in children, only a small proportion of clinical drug trials study pediatric patients. Most pediatric trials are not funded by industry, and the deficiency of evidence is largest in developing countries. (Read the full article)
Macromastia is associated with severe physical and emotional symptoms and negatively impacts health-related quality of life in adult women. Reduction mammaplasty is the most effective treatment for adults. Little is known regarding the impact of macromastia during adolescence.
Adolescents with macromastia have impaired health-related quality of life, lower self-esteem, more breast-related symptoms, and are at higher risk for disordered eating in comparison with their peers. These negative health outcomes have implications for early intervention in this patient population. (Read the full article)
Eating disorder not otherwise specified (EDNOS) is the most common eating disorder diagnosis. Binge eating disorder, 1 type of EDNOS, is associated with obesity among adults. Little is known about the health outcomes associated with other types of EDNOS.
This is the first study to evaluate the prospective association of full and subthreshold bulimia nervosa, binge eating disorder, purging disorder, and other EDNOSs with specific mental and physical health outcomes. (Read the full article)
Persistent facial nerve palsy is a well-described neurologic deficit after Lyme neuroborreliosis and occurs in 13% to 20% of children. Other neurologic deficits are less closely described. Nonspecific subjective symptoms are reported as often among patients as controls in previous short-term follow-up studies.
Persistent neurologic deficits, other than facial nerve palsy, were found in 14% of patients, causing impaired fine motor skills, poor balance, or persistent pain. Nonspecific subjective symptoms were reported as often among patients as controls in this long-term follow-up study and should not be considered as sequelae after Lyme neuroborreliosis. (Read the full article)
Dental composites composed of bisphenol A (BPA) derivatives are common alternatives to amalgam, but may release BPA. Gestational BPA exposure has been associated with poorer behavior in children. A safety trial of amalgam found worse psychosocial outcomes for children randomized to composites.
In the trial, greater exposure to bisphenol-A-glycidyl-methacrylate-based dental composite in children aged 6 to 10 years was associated with worse self-reported psychosocial functioning at 5-year follow-up. There were no such associations with exposure to dental amalgam or urethane-dimethacrylate-based polyacid-modified composite (compomer). (Read the full article)
Sudden infant death syndrome remains the major cause of postneonatal death in developed countries. Although infant-parent bed-sharing following antenatal smoking or maternal consumption of alcohol on the bed-sharing night increases the risk of death, the mechanism is not known.
Bed-sharing infants experienced more oxygen desaturations and episodes of carbon dioxide rebreathing than cot-sleeping infants but showed appropriate behavioral and physiologic responses. A deficit in these responses in vulnerable infants could link to increased risk of sudden infant death syndrome. (Read the full article)
Among adolescents, weight status has been inversely associated with sports participation but not active commuting or physical education. Studies of each form of physical activity have not included adequate adjustments for other physical activities, previous body weight, or diet quality.
Estimates indicate overweight/obesity and obesity prevalence would decrease by 11% and 26%, respectively, if adolescents played on at least 2 sports teams per year; obesity prevalence would decrease by 22% if adolescents walked/biked to school 4–5 days per week. (Read the full article)
Although the impact of changes in the economy on child physical abuse rates is not well understood, there is concern that increased numbers of children may have been victims of physical abuse as a result of the recent economic recession.
Results of this study demonstrate that the rate of admissions for physical abuse to pediatric hospitals has increased during the past 10 years and suggest an association between that increase and the housing mortgage crisis. (Read the full article)
A dose-response relationship exists between light irradiance and decrease of total serum bilirubin concentration (TsB) at relatively low irradiances. It has been questioned whether by increasing irradiance a "saturation point" exists, above which no further decrease of TsB is seen.
We found a linear relation between light irradiance in the range of 20 to 55 μW/cm2/nm and decrease in TsB after 24 hours of therapy, with no evidence of a saturation point. (Read the full article)
The US Surgeon General has determined that the relationship between movie smoking exposure (MSE) and youth smoking is causal; however, it is not known whether movie rating influences how adolescents respond.
The response to PG-13–rated MSE was indistinguishable from R-rated MSE. An R rating for smoking could reduce smoking onset in the United States by 18% (by eliminating PG-13 MSE), an effect similar to making all parents maximally authoritative in their parenting. (Read the full article)
Adolescent dating violence has been studied from the perpetrators' and survivors' perspectives. The risk and protective factors have been explored, and the strength of the association of these factors with adolescent dating violence has been adequately described.
This study assessed the perceptions and practices of school counselors on adolescent dating violence. Knowing school personnel’s practices and perceptions may help researchers and practitioners gain insights into possible ways to alleviate the problem of dating violence in adolescents. (Read the full article)
In humans, evidence for an association between maternal caffeine intake during pregnancy and alterations in fetal brain development with persistent alterations in the offspring’s brain and behavior in later life is inconclusive.
Prenatal caffeine intake is not associated with a higher risk for behavior problems in young children. Results do not provide evidence to advise pregnant women to reduce their caffeine intake to prevent problem behavior in their children. (Read the full article)
Data suggest that delivery at high-volume, high-technology hospitals reduces neonatal mortality. No study has examined other complications or compared the effects in multiple states by using a study design to control for unmeasured differences in case mix.
The survival benefit to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and varies between states. The survival benefits affect both extremely and moderately preterm infants. Complication rates were similar between hospital types. (Read the full article)
Clinical trials have demonstrated that prophylactic human papillomavirus (HPV) vaccines are highly effective in preventing HPV infection, but the impact of vaccination on HPV prevalence rates in real-world, community settings is uncertain.
This study provides evidence of a substantial decrease in the prevalence of vaccine-type HPV among young women and evidence of herd protection in a community only 4 years after the quadrivalent HPV vaccine was licensed. (Read the full article)
Family-centered rounds (FCR) show promise for higher patient care satisfaction. Many previous studies are limited by small sample size and observational or pre-post designs, and health care service outcomes have not been previously examined.
Our study uses an FCR assessment tool and a comparison group of non-FCR patients. We found that FCR are associated with improved family experiences, with no additional burden to health care service use. (Read the full article)
This research presents the first 2 experimental studies on the short-term effects of smoking portrayal in movies on children’s beliefs about smoking.
Exposure to movie smoking from cartoon and family-oriented movies had no effect on implicit associations toward smoking. For smoking beliefs, effects were again small and only statistically significant for social norms regarding smoking. (Read the full article)
Respiratory infectious symptoms are common during the first year of life. Day care attendance, older siblings, and lack of breastfeeding have been considered as possible factors influencing early respiratory tract infections.
Children with early dog contacts seem to have fewer infectious respiratory symptoms and diseases, especially otitis, during the first year of life. (Read the full article)
Siblings and other contacts of abused children, especially twins, are thought to be at higher risk for abuse than other children. However, the rate at which screening tests identify injuries in contacts is currently unknown.
Contacts of abused children with serious injuries have fractures identified on skeletal survey at significant rates. Twins are at substantially increased risk for fracture. Physical examination findings were not sensitive for fractures. (Read the full article)
Moderately preterm-born children (32–356/7 weeks’ gestation) are at risk for both neonatal morbidities after birth and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the developmental delays of this particular group.
Of all neonatal morbidities commonly seen in moderately preterm-born children, only hypoglycemia increased the risk of developmental delay after moderately preterm birth. A concerted effort to prevent hypoglycemia after birth might enhance developmental outcome in this group. (Read the full article)
Physical punishment is associated with aggression, delinquency, and internalizing conditions in childhood, as well as a range of Axis I mental disorders in adulthood. More research is needed on the possible long-term relationship between physical punishment and mental health.
To our knowledge, this is the first nationally representative examination of physical punishment and a range of Axis I and II disorders, gender interactions, and proportion of mental disorders in the general population that may be attributable to physical punishment. (Read the full article)
Sudden cardiac death in young athletes is an uncommon but devastating event. Addition of routine electrocardiogram (ECG) screening to standard preparticipation care may reduce the number of sudden deaths. Lack of data regarding effectiveness and costs has prevented widespread implementation.
Adding ECG screening to current preparticipation evaluation is not cost-effective. Cost is driven primarily by the evaluation of the large number of false-positive findings. An ECG-only screening strategy is more cost-effective. (Read the full article)
Childhood abuse has been associated with obesity risk in adulthood. Little is known regarding the impact of abuse severity on risk, potential mechanisms are poorly understood, and few studies have been conducted among minority populations.
Severity of child/teenager physical and sexual abuse is associated with increased risk for adult obesity and/or central adiposity in adulthood. These are the first such findings in a large cohort of US black women. (Read the full article)
Late preterm infants are at risk for a variety of developmental impairments; however, little is known about developmental differences among children born within the term range of 37 to 41 weeks’ gestation.
This study links comprehensive birth record data from 128 050 term births to children’s school records 8 years later. Analyses establish that, even among the "normal term" range, gestational age is an important independent predictor of academic achievement. (Read the full article)