Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.
This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings. (Read the full article)
Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-of-care ultrasound in skull fracture diagnosis.
Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care. (Read the full article)
Public health policy focuses on reducing formula use for breastfed infants during the birth hospitalization. Observational evidence supports this approach, but no previous studies have examined the effect of early use of small volumes of formula on eventual breastfeeding duration.
Use of limited volumes of formula during the birth hospitalization may improve breastfeeding duration for newborns with high early weight loss. Reducing the use of formula during the birth hospitalization could be detrimental for some subpopulations of healthy term newborns. (Read the full article)
Blood lead levels well below 10 µg/dL are now recognized as causing adverse cognitive effects, including lower scores on standardized reading and math tests.
This is the first study to show that reading readiness early in kindergarten is independently associated with blood lead levels well below 10 µg/dL. Results suggest that lead exposure may have a larger impact on urban education than national estimates suggest. (Read the full article)
Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.
Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment. (Read the full article)
Cognitive behavioral therapy is an effective and safe treatment of chronic fatigue syndrome in children and adolescents. After 6 months, Internet-based cognitive behavioral therapy in the form of FITNET led to an 8 times higher chance of recovery compared with usual care.
The positive effects of FITNET were maintained at long-term follow-up (>2.5 years).Patients following usual-care treatment achieve similar recovery rates at long-term follow-up. (Read the full article)
The American Academy of Pediatrics recommends that all preterm infants receive human milk; however, little is known about the use of human milk in US advanced care neonatal units.
Routine use of human milk and use of donor milk in neonatal advanced care units increased from 2007 to 2011, particularly among units providing intensive care. There is geographic variation in the use of human milk in these units. (Read the full article)
Before the introduction of conjugate pneumococcal vaccines and routine penicillin prophylaxis, febrile patients with sickle cell disease were known to have a 3% to 5% risk of bacteremia. Consequently, hospitalization rates for febrile episodes are >70%.
We observed no mortality or morbidity among those managed completely as outpatients, and bacteremia occurred in <1%. Physicians should strongly consider outpatient management of febrile children with sickle cell disease if there are no other indications for admission. (Read the full article)
The importance of transition from pediatric to adult health care for youth with special health care needs has gained increasing attention over the past decade, but fewer than half of this population received needed transition preparation in 2005–2006.
This study reports on transition findings from the 2009–2010 National Survey of Children with Special Health Care Needs and finds no discernible improvements since 2005–2006. New clinical recommendations and care processes should help to accelerate transition improvements in the future. (Read the full article)
Hospitalizations under observation status are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied.
Children’s hospitals use observation status with great variation. Resource utilization for pediatric patients under observation status overlaps substantially with inpatient-status utilization, calling into question the utility of segmenting pediatric patients according to billing status. (Read the full article)
A low-level risk of intussusception after rotavirus vaccines, ~1 to 2 cases per 100 000 vaccinees, exists in some settings. In the United States, a risk of 1 in 65 000 was excluded, but lower risk could exist.
A persistent clustering of intussusception events 3 to 6 days after dose 1 indicates the possibility of a low-level risk of intussusception of ~0.8 cases per 100 000 vaccinees. The documented benefits of rotavirus vaccine far outweigh this low-level risk of intussusception. (Read the full article)
Distracted driving due to texting while driving (TWD) has emerged as an important teenage safety issue. Previous studies have shown that the self-reported prevalence of TWD among teenagers varies widely.
In 2011, 45% of US high school students aged ≥16 years reported TWD during the past 30 days. TWD was positively associated with other risky motor vehicle behaviors; this association strengthened as frequency of TWD increased. (Read the full article)
Infants with a diverse gut microbial flora are less likely to develop eczema and allergy.
Parental sucking of their infant’s pacifier is associated with a reduced risk of allergy development and an altered oral flora in their child. Transfer of oral microbes from parent to infant via the pacifier might be used in primary prevention. (Read the full article)
Studies reveal that mothers of infants with colic (defined by Wessel’s criteria of >3 hours per day of distress) are more likely to develop depression. No studies have examined whether the consolability of infant crying predicts maternal depression risk.
Prolonged inconsolable infant crying has a stronger association with maternal depressive symptoms than overall daily duration of fussing and crying, suggesting that a mother’s report of inability to soothe her infant may be a powerful indicator of her depression risk. (Read the full article)
Despite evidence on how malpractice risk varies according to physician specialty, there is growing but still limited evidence about malpractice among US pediatricians. The frequency of malpractice claims against pediatricians is low among specialties, but payments are among the highest.
This study describes malpractice risk among US pediatricians using data from a nationwide liability insurer covering 1630 pediatricians from 1991 to 2005. It compares pediatric malpractice experience with other specialties and studies patient factors associated with pediatric malpractice claims. (Read the full article)
Yearly influenza immunization is recommended in patients with inflammatory bowel disease (IBD). However, concern regarding vaccine-related adverse events may limit uptake, and case reports in the literature detail disease flares after immunization.
Influenza immunization rates in children with IBD are low but immunization did not result in increased outpatient visits, hospitalizations or emergency visits. Immunization was associated with fewer IBD-related visits in the post-vaccine period, which may indicate protection against IBD symptoms. (Read the full article)
Extremely preterm infants who receive antihypotensive therapy have worse outcomes than untreated infants. The reasons for this are not clear. High-quality randomized trials have not been performed to date because of logistical challenges, thereby necessitating alternative methods of investigation.
Antihypotensive therapy administration was not associated with improved in-hospital outcomes for any of the 15 definitions of low blood pressure investigated. Alternative methods of deciding who to treat are needed to maximize patient benefit and minimize harm. (Read the full article)
Hydrocarbons are dangerous household products commonly found in homes with young children. Unintentional ingestion continues to be a problem despite existing prevention efforts. Aspiration is often associated with ingestion of hydrocarbons by children.
The National Poison Database System and National Electronic Injury Surveillance System data sets demonstrate similar rates of hydrocarbon-related injuries in children. Rates of hydrocarbon exposure were highest in summer. Gasoline was the product most associated with hydrocarbon injuries. (Read the full article)
Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous large-scale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context.
We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. (Read the full article)
Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.
Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. (Read the full article)
The systemic nonselective β-blocker propranolol hydrochloride is increasingly used as first-line management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned.
This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas. (Read the full article)
Botulinum spores are ubiquitous, found in the soil of most countries worldwide, and also in honey. It is well established that ingestion of honey by children aged <1 year can lead to infant botulism.
This study examines the prevalence of honey pacifier use among a pediatric population aged <1 year. We also assessed parental knowledge of the dangers of giving honey to children in this age group. (Read the full article)
Neuropsychiatric conditions comprise a substantial and growing disease burden among children. Pharmacotherapy represents an important treatment option for these conditions, although most drugs are not approved for use in children.
Very few drug trials studying neuropsychiatric conditions focus on children. Furthermore, these trials examine and provide pediatric evidence for only a fraction of all available drugs in the treatment of common neuropsychiatric conditions. (Read the full article)
Prompt, high-quality diagnosis of acute pyelonephritis and later identification of children with scarring are important to prevent future complications. Examination by dimercaptosuccinic acid scan is the current clinical gold standard but is not routinely performed.
Procalcitonin demonstrated a more robust predictive ability, compared with C-reactive protein or white blood cell count, to selectively identify both children who had acute pyelonephritis during the early stage of urinary tract infections, as well as those with late scarring. (Read the full article)
The Ages and Stages Questionnaires (ASQ) has been validated in many countries and translated into numerous languages. In most publications, it has been reported that the ASQ is accurate in detecting true problems in apparently healthy children and even in children with biological risk factors.
This report compares the third version of the ASQ and the Bayley Scales of Infant and Toddler Development, Third Edition, assessments. Psychometric properties showed a tendency to improve with testing age and when comparing term versus extremely preterm children. (Read the full article)
Juice consumption among 2- to 5-year-old children exceeds dietary recommendations. In 2007, the US Department of Agriculture revised the composition and quantities of prescribed foods in WIC food packages to align them with dietary guidelines. Juice allowances were reduced by approximately half.
WIC participants purchased about a quarter less juice volume after implementation of the revised WIC packages. Large reductions in WIC-provided juice were only partly compensated for by extra juice purchases with non-WIC funds. Little compensation occurred for other beverages. (Read the full article)
Children are taking more medications than ever before. Medication errors in the hospital are common. Less is known about the medication errors that occur in children's homes, and there are no studies that examine the entire process.
We reviewed 963 medications in the homes of children with cancer at 3 sites. We found 3.6 errors with injury and 36 errors with potential for injury per 100 patients. Interventions should target common and dangerous errors at home. (Read the full article)
Current recommendations to prevent warts focus on limiting the personal spread of human papillomavirus and transmission in public places, such as swimming pools; however, evidence on risk factors for developing warts is limited.
Cutaneous human papillomavirus in primary schoolchildren is primarily transmitted in the family and school class. This suggests that recommendations should shift toward reducing transmission in families and school classes. (Read the full article)
Health care–associated infections cause considerable morbidity and mortality among hospitalized children. Simple barrier precautions such as universal gloving of health care workers’ hands may reduce transmission of infectious agents between patients.
Mandatory use of gloves during respiratory syncytial virus season in pediatric units prevented other health care–associated infections such as central line–associated bloodstream infections, particularly in intensive care settings. These secondary benefits suggest continuing mandatory gloving throughout the year. (Read the full article)
Despite numerous studies, evidence of the association between food-related parenting practices and child weight remains equivocal. Examination of this association within a sample of diverse adolescents is needed to inform anticipatory guidance provided by physicians working with parents of adolescents.
The current study explores associations between food-related parenting practices and weight status in a population-based sample of parent-adolescent pairs. This diverse sample allows for an in-depth examination of the role of gender, race/ethnicity, socioeconomic status, and grade level in this association. (Read the full article)
Perforation in the setting of retained esophageal foreign body is rare, but can be catastrophic. The role of imaging in screening for injury after removal has not previously been studied.
The rate of esophageal injury among children with retained esophageal foreign body is 1.3%. Intraoperative findings suggestive of injury are predictive of perforation. Routine chest radiography is not warranted in those who do not meet this criterion. (Read the full article)
Heated, humidified high-flow nasal cannula (HHHFNC) is a noninvasive mode of respiratory support that is commonly used in the majority of US NICUs. No large randomized trial has evaluated safety or efficacy of HHHFNC.
This large randomized controlled trial suggests that HHHFNC is as effective as nCPAP for noninvasive respiratory support and can be safely applied to a wide range of neonates. (Read the full article)
Studies suggest that young adults have worse access to health care, use less primary care, and visit emergency departments more frequently than adolescents. Whether these differences are present between adolescents and young adults with asthma is unknown.
Young adults with asthma were less likely to have a usual source of care and use primary care. In contrast, they were more likely to use the emergency department. Adjusting for insurance coverage reduced these differences partially but not completely. (Read the full article)
Survival of children with spinal muscular atrophy type 1 is determined by treatment choice: tracheostomy with mechanical ventilation, noninvasive mechanical ventilation, or a palliative approach. Few data are available on life expectancies with different approaches.
The present study provides data comparing therapeutic strategies that affect life expectancy. Clinicians involved in the care of patients with spinal muscular atrophy type 1 should be aware of survival trends while awaiting more definitive therapeutic strategies. (Read the full article)
Parents of children with chronic cough have poor quality of life and often seek multiple consultations. There are few randomized controlled trials on the management of cough or on the efficacy of management algorithms outside of inpatient settings.
In a multicenter, trial, we found that the management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes. Earlier application of the algorithm leads to earlier cough resolution and improved parental quality of life. (Read the full article)
Pulse oximetry testing in newborns can detect asymptomatic cases of critical congenital heart defects and has been added to the US Recommended Uniform Screening Panel. However, the impact that earlier diagnosis may have on survival in this population is unclear.
One-year survival for infants with critical congenital heart defects has been improving over time, yet mortality remains high. Survival has been greatest for those diagnosed after 1 day of age and may increase more with screening using pulse oximetry. (Read the full article)
Cognitive and motor developmental test scores of preterm and late preterm infants increase with gestational age. Developmental test scores in full-term infants have not previously been considered to relate to gestational age.
In a cohort of healthy, full-term infants, 37 to 41 weeks, 12-month mental and psychomotor scores on the Bayley Scales of Infant Development increased with gestational age, suggesting that neurodevelopment is optimal in infants born at 39 to 41 weeks. (Read the full article)
Antibiotics-induced rash in Epstein-Barr virus acute infectious mononucleosis, especially the aminopenicillins-induced type, was first described during the 1960s, with a reported incidence of 80% to 100%. This phenomenon was not further investigated but is well-established in pediatric textbooks.
The main observation of this study is that rash induced by amoxicillin in confirmed Epstein-Barr virus acute infectious mononucleosis was found at a rate of ~30%, which is much lower than previously reported. (Read the full article)
At least half of the achievement gap for low-income, minority children is present at kindergarten entry; however, there are no population-level early childhood interventions that effectively engage and support families and teachers to ameliorate the impact of adversity on achievement.
This study evaluated ParentCorps, a family-centered, school-based intervention to promote self-regulation and learning for all children entering school in disadvantaged, urban neighborhoods. ParentCorps results in higher kindergarten achievement among low-income, minority children. (Read the full article)
Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on parent-report is associated with gross motor skills in children with cerebral palsy (CP), however this underestimates prevalence. Almost all children with severe CP have dysphagia; little is known about mild CP.
The prevalence of directly assessed OPD in preschool children with CP is 85% (70% in GMFCS I; 100% in GMFCS V). OPD was prevalent even in mild CP. Gross motor functional capacity is strongly related to dysphagia severity and prevalence. (Read the full article)
Previous studies have found a relationship between exclusive breastfeeding for ≥6 months and iron deficiency. Little is known about the relationship between total breastfeeding duration, including the period after the introduction of complementary foods, and infant iron status.
Our results suggest that infants with longer total breastfeeding duration may be at risk for iron deficiency. Our findings highlight a clinically important association warranting additional investigation that may inform future guideline updates regarding assessment of risk for iron deficiency in young infants. (Read the full article)
Electronic health record (EHR) uptake by US hospitals has been slow, including among children’s hospitals. The Health Information Technology for Economic and Clinical Health program, which began in 2011, offers incentives for adoption and meaningful use of EHRs.
Using an annual survey, we evaluated how children’s hospitals have progressed in EHR adoption from 2008 through the start of the Health Information Technology for Economic and Clinical Health program and assessed their ability to meaningfully use EHRs. (Read the full article)
Previous studies have suggested that health care providers, family members, friends, and others play a role in shaping parents’ vaccination decisions. Other research has suggested that the media can influence whether parents decide to vaccinate their children.
Through the application of social network analysis, this study formally examines and quantifies how parents are influenced by the people and sources around them. Its findings suggest that social networks are important, particularly for parents who do not completely vaccinate. (Read the full article)
Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants.
Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents. (Read the full article)
The incidence of childhood and adolescent melanoma has been significantly increasing up to 2004. Risk factors (fair skin, light-colored hair/eyes, female gender, presence of nevi, family history, increased number of sunburns, and exposure to UV radiation) are associated with melanoma.
This study describes incidence trends of melanoma diagnosed between the ages of 0 and 19 years and from 1973 through 2009 by gender, stage and age at diagnosis, primary site, and exposure to UV radiation. (Read the full article)
Forgoing artificial nutrition and hydration in children at the end of life is an acceptable practice under some circumstances. However, there is a paucity of pediatric evidence to guide health care providers’ and parents’ decision-making around this practice.
This study describes experiences of parents whose children died after forgoing artificial nutrition and hydration. All parents were satisfied with their decision and believed their child’s death was peaceful. This study adds to the limited evidence to guide clinical practice. (Read the full article)
Advances in the treatment of critically ill infants have increased survival of extremely low/very low birth weight and medically complex infants. Improved survival can result in prolonged mechanical ventilation and sometimes tracheostomy. Current tracheostomy rates for these infants are unknown.
This long-term review of infants discharged from a NICU with tracheostomies is the first to describe tracheostomy rates specifically in extremely low/very low birth weight infants. It focuses on long-term clinical outcomes and comorbidities rather than surgical complications. (Read the full article)
Research has shown that dishware size influences self-served portion sizes and meal intake in adults. In children, larger bowls led children to request more food, but whether larger dishware affects children’s self-served portions or intake at meals is not known.
We assessed the effect of increasing dishware size on self-served portions and intake in young children. Larger plates and bowls resulted in larger self-served portions, and indirectly promoted greater intake, emphasizing the importance of age-appropriate dishware. (Read the full article)
Clinically significant bleeding in pediatric immune thrombocytopenia (ITP) is rare. Evidence-based guidelines for the management of pediatric ITP recommend that patients with mild or no bleeding be followed with observation alone.
Many pediatric patients with newly diagnosed ITP continue to be managed in the inpatient setting. Bleeding events are rare in this setting. Although geographic variability exists, intravenous immunoglobulin is the most commonly used inpatient ITP treatment in the United States. (Read the full article)
Short sleep may be an adolescent obesity risk factor, but most evidence is from cross-sectional studies. Three longitudinal studies have investigated the association between sleep duration and adolescent obesity, finding mixed results.
Shorter sleep was associated with increases in BMI from age 14 to 18, especially at the upper tail of the BMI distribution. Increasing daily sleep to 10 hours per day could help to prevent adolescent obesity. (Read the full article)