Nonadherence to antiretroviral therapy among children and youth with HIV is a frequent problem that can result in treatment failure and disease progression for this population. Children and adolescents face different barriers to adherence than adults infected with HIV.

Few studies have examined specific barriers to adherence as reported by children with perinatally acquired HIV and their caregivers. This report examines the agreement between child and caregiver perceptions of adherence barriers and the factors associated with these barriers. (Read the full article)

Existing clinical research policy does not guarantee availability of results. Registration on the Web site ClinicalTrials.gov and the Food and Drug Administration Amendments Act improved transparency in pediatric clinical research. Registration and publication remain voluntary for many trials involving children.

Only 29% of completed registered studies and 53% of National Institutes of Health–funded trials involving children were published. Numbers of studies are increasing. Registration and posting of results on ClinicalTrials.gov should be mandatory for all studies involving children. (Read the full article)

Survival of children born with Down syndrome has been improving, but few studies have used population-based data to examine the influence of fetal and maternal characteristics on survival.

This study examined predictors of survival for children born with Down syndrome using population-based data from the UK Northern Congenital Abnormality Survey and shows that year of birth, gestational age, birth weight, and presence of additional anomalies influence survival status. (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)

Implementing expanded vaccination recommendations has challenged primary care providers, who administer the majority of vaccines in the United States. School-located vaccination has been proposed as a means of increasing vaccination rates while reducing the burden on primary care providers.

This study assesses physicians’ support for their patients’ receipt of vaccines in school. Additionally, it compares physicians’ support for adolescent versus influenza vaccination and compares support by insurance status of their patient. (Read the full article)

There are limited data regarding the current status of the pediatric clinical trial enterprise.

Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible. (Read the full article)

Infant behavioral dysregulation is a common concern, involving irritability, excessive crying, and problems with feeding and sleep. Previous research into its behavioral outcomes has been limited by small cohorts and short follow-up, and findings have been contradictory.

Long-term follow-up of a large cohort showed that infant behavioral dysregulation was a risk factor for maternal-reported behavior concerns at 5 and 14 years, but was unrelated to young adult mental health outcomes. (Read the full article)

Most term and late preterm infants with neonatal encephalopathy have not had recognized asphyxial birth events. Several nonasphyxial risk factors for neonatal encephalopathy have been identified in previous studies.

In a large sample, we confirm the association of several nonasphyxial factors with neonatal encephalopathy, including markers of intrauterine exposure to infection or inflammation, intrauterine fetal growth restriction, and birth defects. We identify steps that would improve studies of neonatal encephalopathy. (Read the full article)

Previous studies have found variable child care provider compliance with American Academy of Pediatrics child care illness exclusion guidelines and high rates of unnecessary exclusion of mildly ill children from child care.

Our study is the first to compare child care directors’ return-to-child care practices before the release of the new American Academy of Pediatrics return-to-child care guidelines and to describe the guidelines’ impact if actively adopted by child care providers. (Read the full article)

It has been suggested that maternal immune activation during pregnancy is associated with cardinal behaviors of autism in the offspring. Epidemiologic studies have yielded conflicting results concerning the association between any infection during pregnancy and the development of autism.

This population-based cohort study investigated the association between specific common infectious diseases, febrile episodes, or use of antibiotics during pregnancy by using maternal population-based self-reported data. (Read the full article)

Some children with gastroenteritis fail to respond to oral rehydration. Subsequent interventions are dictated by regional preference. In North America, nasogastric rehydration is rarely administered. Caregiver and health care providers’ perspectives regarding its use have not been described previously.

Both caregivers and health care providers would select intravenous rehydration instead of nasogastric rehydration when oral rehydration fails. Greater knowledge mobilization efforts will be required for nasogastric rehydration to be adopted into clinical practice. (Read the full article)

Knowledge is limited regarding the epidemiology of persistent pulmonary hypertension of the newborn (PPHN). Previous work has implicated a host of perinatal risk factors and a few antenatal antecedents of PPHN, including maternal consumption during pregnancy of nonsteroidal antiinflammatory medications.

In contrast to results of previous studies, we found no association between PPHN and maternal consumption during late pregnancy of nonsteroidal antiinflammatory drugs in general or ibuprofen in particular. (Read the full article)

Maternal obesity is an increasingly important public health concern and may adversely affect central nervous system development in offspring. However, few studies have explored the relationship between maternal prepregnancy BMI and neurodevelopmental outcomes in children, with conflicting results.

Using data from a large and contemporary UK birth cohort, we found that maternal prepregnancy BMI is negatively associated with children’s cognitive performance. The relationship appears to become stronger as children get older, although the overall effect size is modest. (Read the full article)

Although survival of children born with Down syndrome has improved, unexplained racial and ethnic disparities in survival persist in the United States.

This study used population-based data from 10 birth defects monitoring programs in the United States to examine survival trends among children born with Down syndrome and to evaluate the changing influence of survival predictors over the life course. (Read the full article)

In humans, the brain growth spurt begins in the last trimester of pregnancy and extends through the first 2 years of life. Studies show poor cognitive and motor development among children who have iron deficiency anemia in infancy.

Prenatal iron deficiency anemia in the third trimester affects child mental development. Prenatal micronutrient supplementation with sufficient iron protects child mental development even when the woman’s iron deficiency anemia is not properly corrected during pregnancy. (Read the full article)

UV radiation exposure in tanning beds is associated with an increased risk of skin cancer. Because of the rising rate of melanoma, the World Health Organization recommends that persons <18 years of age not use tanning devices.

Despite scientific evidence to the contrary, tanning facilities in Missouri, a state without indoor-tanning regulations, often misinformed consumers regarding the risk of skin cancer and would allow children as young as 10 years old to use tanning devices. (Read the full article)

In Mexico, substantial declines in childhood diarrhea deaths have been documented since the introduction of the rotavirus vaccine in 2007. However, there is concern of lower vaccine effectiveness in less developed regions of Mexico with higher diarrhea-related mortality.

We documented significant and comparable declines across all 3 regions of Mexico with different levels of development, indicating equitable vaccine distribution to children with varying risk of mortality and reaffirming the beneficial effects of rotavirus vaccination against fatal diarrheal disease. (Read the full article)

The etiology of congenital heart defects (CHDs) is largely unknown. A few studies have suggested that maternal emotional stress around the time of conception may be related to the occurrence of CHDs.

Using a large registry-based data source from Denmark, we found that prenatal exposure to maternal bereavement, as a marker of severe stress exposure, may increase the prevalence of CHDs in offspring. (Read the full article)

Among adolescents younger than 15, 18% have had sex and 16 000 pregnancies occur annually; among those aged 15 to 17, 30% have had sex and 252 000 get pregnant. Information on the youngest adolescents has not been previously published.

Sexual activity and pregnancy are rare among 10-, 11-, and 12-year-olds, and sex is more likely to be nonconsensual. This arguably represents a different public health issue than sex among older teens, who have a greater need for contraception. (Read the full article)

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)

Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.

This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. (Read the full article)

Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes.

This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. (Read the full article)

Shared decision-making involves the assessment of preferences and goals and has been prioritized in new attention-deficit/hyperactivity disorder treatment guidelines, yet no studies have examined the impact of both preferences and goals on treatment initiation.

Supporting the clinical utility of preference and goal assessment, we found that parental treatment preferences are associated with treatment initiation, and those with distinct goals select different treatments. (Read the full article)

Several studies have been published evaluating the impact of 2011 Accreditation Council for Graduate Medical Education duty hour regulations. Although resident quality of life may be improved, it appears that resident education and patient care may be worse.

This is the first study to evaluate pediatric program director approval of 2011 Accreditation Council for Graduate Medical Education Common Program Requirements and the perceived impact of the regulations on patient care, resident education, and quality of life. (Read the full article)

Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time.

This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. (Read the full article)

A serum 25-hydroxyvitamin D (25(OH)D) concentration of 20 ng/mL meets the requirements of at least 97.5% of the population older than 1 year. A recommended dietary intake to achieve this serum 25(OH)D concentration has not been established during infancy.

Daily maternal (during pregnancy) and then infant vitamin supplementation with 1000/400 IU or 2000/800 IU increases the proportion of infants with 25(OH)D ≥20 ng/mL during infancy with the higher dose sustaining this increase for longer. (Read the full article)

Mobile devices are ubiquitous in children’s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiver–child interactions, has not been studied.

In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction. (Read the full article)

Several studies suggest that excessive media use in early childhood predicts poorer developmental outcomes. It has not been studied whether infants with self-regulation problems, who may be at higher developmental risk, develop excessive media use habits.

This study shows that infants and toddlers with self-regulation difficulties (ie, problems with self-soothing, sleep, emotional regulation, and attention) view more media at 2 years of age, independent of other important confounders. (Read the full article)

Early establishment of a dental home is critical for addressing the "silent epidemic" of early childhood caries. Physicians and dentists have worked to improve children’s access to dental care, but little is known about caregivers’ role in this context.

Addressing factors that affect the establishment of a child’s dental home, such as caregivers’ dental neglect and problem-driven care-seeking behaviors, is essential. Caregiver engagement seems to be pivotal for increasing use of preventive services while decreasing episodic and problem-initiated care. (Read the full article)

Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.

Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families. (Read the full article)

Passive or opt-out consent has been successfully used to recruit subjects in several investigational studies. However, institutional review boards are often inconsistent in their application of federal regulations regarding passive consent.

This study documented the variability among 24 local institutional review boards in their application of federal regulations regarding passive consent and parental acceptance of a passive consent strategy in a multicenter pediatric study. (Read the full article)

Prenatal maternal smoking has been associated with attention-deficit/hyperactivity disorder in children, but the causal nature of this association is unclear. Controlling for the association with paternal smoking has been inconsistent.

Women who used nicotine replacement also had children with a higher risk of attention-deficit/hyperactivity disorder. Mother's smoking behavior appears more important than father's, suggesting a possible causal effect of nicotine exposure or factors related to maternal nicotine dependence. (Read the full article)

Restrictive feeding by parents is associated with poorer eating self-regulation and increased child weight status. However, this association could be due to confounding home environmental or genetic factors that are challenging to control.

Differential maternal restrictive feeding is associated with differences in twins' caloric compensation and BMI z score. Controlling for the shared home environment and partially for genetics, these findings further support a true (ie, unconfounded) association between restriction and childhood obesity. (Read the full article)

Professional organizations recommend ultrasound as the initial diagnostic imaging modality for children with suspected nephrolithiasis. Computed tomography utilization for children with nephrolithiasis treated at freestanding children’s hospitals is common and varies substantially by hospital.

The high prevalence and regional variability of CT as the first imaging study for children with nephrolithiasis who presented to emergency departments, outpatient clinics, and hospitals throughout the United States indicate that current imaging practices deviate substantially from guidelines. (Read the full article)

Studies have shown that setbacks, such as receiving low school grades, lead children to experience negative self-feelings (eg, shame, insecurity, powerlessness). Psychological theory predicts that unconditional regard can buffer this adverse impact of setbacks. However, causal evidence is lacking.

This randomized field experiment shows that briefly reflecting on experiences of unconditional regard buffers children’s negative self-feelings after an academic setback 3 weeks later. Unconditional regard may thus be an important psychological lever to reduce negative self-feelings in youth. (Read the full article)

Previous studies have examined state regulations for child care facilities and found substantial variation among states. None of these studies examined regulations related to healthy sleep practices, which is an important and often overlooked intervention target for obesity prevention.

We reviewed state regulations related to healthy sleep in child care and compared them to recent national recommendations put forth by the Institute of Medicine. We found that many states lacked regulations, highlighting an important and timely opportunity for improvement. (Read the full article)

Frequency of influenza vaccination is low, partially because of missed opportunities to vaccinate. Barriers to implementing successful influenza vaccination reminders in the electronic health record include alert fatigue and incomplete vaccination information due to scattered records.

A noninterruptive, immunization information system–linked influenza vaccination reminder can increase vaccination late in the winter when fewer vaccine doses are usually administered. Tailoring the reminder to clinicians’ needs can increase its use. (Read the full article)

Application of antenatal corticosteroids to mothers before delivery is highly beneficial to very low birth weight infants. Yet despite widespread quality improvement efforts, many eligible infants fail to receive this therapy.

We demonstrate improvement in antenatal corticosteroid use during the study period. However, significant regional variation persists, which network-level quality improvement efforts might help eliminate. (Read the full article)

Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied.

Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits. (Read the full article)

Asthma is one of the most common chronic diseases in children. It has been suggested that maternal depression during pregnancy is associated with asthma in the offspring, but the role of antidepressant use during pregnancy is not known.

In our prospective cohort study, we found that maternal antidepressant use during pregnancy generally did not increase the risk of asthma except for use of older antidepressants, which could reflect confounding by the severity of maternal depression. (Read the full article)

Smoking has been found to increase the risk of some specific congenital anomalies; however, results remain inconsistent. Nicotine replacement therapy (NRT) is increasingly being used as for smoking cessation in pregnancy although little is known about its association with congenital anomalies.

Being prescribed NRT while pregnant was not associated with major congenital anomalies (MCA), except a small increase in respiratory anomalies (3/1000 births). This must be considered in context of the rarity of MCAs and higher morbidities in the NRT group. (Read the full article)

Both obesity and developmental disabilities have increased in recent decades; however, the full long-term effects of prepregnancy obesity on a child’s psychosocial development remain unknown. Limited studies suggest associations between maternal prepregnancy obesity and child psychosocial development.

This study in 6-year-old children provides evidence that severe prepregnancy obesity is associated with adverse child psychosocial outcomes, including attention-deficit/hyperactivity disorder. These findings were not explained by many pregnancy and postpartum factors related to maternal obesity or child development. (Read the full article)

Fifteen percent of tuberculosis cases globally are resistant to the drug isoniazid. Isoniazid resistance puts patients with tuberculosis at risk for poor treatment outcomes and threatens the effectiveness of isoniazid preventive therapy in people with latent tuberculosis infection.

We present the first global and regional estimates of the proportion of children with tuberculosis who have isoniazid-resistant disease, showing large geographic variations in risk of resistance. We estimate the number of annual incident cases of isoniazid-resistant tuberculosis in children. (Read the full article)

Both short and long interpregnancy intervals are associated with increased risk of autism in second-born children. However, it is not known if the association is explained by unfavorable birth outcomes of the previous siblings.

Both short and long interpregnancy intervals increase risk of autism in second-born children independently of previous siblings being born premature, having low birth weight, or being born by cesarean delivery and independently of maternal antidepressant use 3 months before pregnancy. (Read the full article)

Previous studies have shown racial differences in invasive pneumococcal disease (IPD) rates. Recent studies demonstrated a national decline in IPD rates after 13-valent pneumococcal conjugate vaccine (PCV13) introduction. The impact of PCV13 on racial and regional differences in IPD rates among Tennessee children is unknown.

After introduction of PCV13, pediatric IPD rates, including disease due to antibiotic-resistant strains, declined substantially. Racial and regional differences in IPD rates were no longer significant. Our study illustrates the impact of PCV13 and the importance of continued IPD surveillance. (Read the full article)

The Financial Sector Conduct Authority warns the public not to conduct financial services business with Masibekele Funeral Parlour and MISI Burial Society.

A Fin24 reader who bought a property in December 2019 sent his registration papers off just before the lockdown was announced, which was unfortunately too late. A property law expert responds.

16 May 2013The Regulatory Reform (Scotland) Bill was introduced in the Scottish Parliament on 27 March 2013. This briefing provides background information on existing regulatory regimes, and the introduction of the Bill.

13 January 2013This briefing provides a summary of the parliamentary scrutiny of the Regulatory Reform (Scotland) Bill prior to Stage 3 proceedings which are scheduled to take place on 16 January 2014.