Rates of coverage for recommended vaccinations in adolescents are substantially lower than Healthy People 2010 goals. Reminder/recall is an evidence-based strategy that is proven to increase immunization rates in both adults and young children.

This study shows that reminder/recall is effective in increasing adolescent immunization rates. Practices may also benefit financially from conducting reminder/recall in this age group if they are able to generate additional well visits and keep supply costs low. (Read the full article)

More than one-tenth pediatric patients use complementary and alternative medicines (CAM) for their medial conditions in the United States. Traditional Chinese medicine (TCM) is the most commonly used CAM in East Asia but large-scale epidemiologic studies are lacking.

In comparing TCM and non-TCM users among children in Taiwan, children’s age and parental TCM use were strongly associated with TCM use. Additionally, dyspepsia and allergic rhinitis were positively related to increasing TCM use. (Read the full article)

Treatment of adolescent migraine remains a significant unmet medical need. In adults, the combination of sumatriptan and naproxen sodium has demonstrated superior efficacy, with similar tolerability, to its components in the acute treatment of migraine.

This study constitutes the first large-scale, placebo-controlled evidence for the acute relief of adolescent migraine pain and associated symptoms with an oral medication. (Read the full article)

Omega-3 fatty acids (O3FA) are commonly used as complementary treatments in pediatric psychiatric disorders, including Tourette’s disorder (TD), and are well known to have anti-inflammatory properties. However, no studies to date have examined the effects of O3FA on pediatric TD.

This is the first double-blind, placebo-controlled clinical trial of O3FA in pediatric TD. The results indicate that O3FA supplementation may be beneficial in the reduction of tic-related impairment for some children and adolescents with TD, but not tics per se. (Read the full article)

Some researchers have suggested that individuals with Down syndrome (DS) are protected from atherosclerotic disease; however, recent data from 2 large cohort studies of individuals with DS are significant for increased mortality from ischemic heart disease and cerebrovascular disease.

This study compares lipid profiles among children with DS and their siblings, highlighting the presence of a less favorable lipid profile in this high-risk population. (Read the full article)

Despite recommendations and a universal immunization program, a recent survey reported suboptimal influenza vaccination coverage in children aged 6 to 23 months in Ontario. Little is known about predictors of coverage in young children to target immunization strategies.

Full influenza vaccination coverage in young children in Ontario is <10% and declining since the 2006–2007 season. Medically high-risk children including low birth weight infants are more likely to be immunized, but maternal and health services characteristics remain important. (Read the full article)

Isolated methylmalonic acidemia, one of the most common inborn errors of organic acid metabolism, is known to be associated with variably impaired intellectual functioning and severe biochemical and clinical abnormalities. However, the neurocognitive outcomes have yet to be fully described.

This research defines the neurocognitive phenotype of isolated methylmalonic acidemia and identifies processing speed as a specific impairment. Clinical, biochemical, and molecular genetic covariates were explored. A history of hyperammonemia at diagnosis was found to correlate with poorer cognitive outcomes. (Read the full article)

A single inhalation of laninamivir octanoate has previously been shown to be as effective as repeated doses of zanamivir in vitro and in vivo, but it is not known whether this is also the case for children.

Median time to fever resolution was not significantly different between laninamivir octanoate and zanamivir for pediatric patients with influenza. The severity of influenza symptoms and the frequency of complications were similar in the 2 groups. (Read the full article)

Overweight and obese children have a higher prevalence of several cardiovascular disease (CVD) risk factors. There is growing evidence demonstrating that CVD risk factors present during childhood persist into adulthood.

US adolescents had no significant change in prehypertension/hypertension and borderline-high/ high low-density lipoprotein cholesterol prevalence from 1999–2000 to 2007–2008; however, prediabetes/diabetes increased by 14%. (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)

The association of retinal hemorrhages (RHs) with abusive head trauma (AHT) is robust; 46% to 100% RHs are reported in AHT. There is potential selection bias with risk of circular reasoning because the majority of studies describing RH focus on AHT.

This is the first prospective observational study defining prevalence and distribution of RH in critically ill children excluding those with AHT. Severe multilayered RH were rare and observed in children with accidental fatal head injury, severe coagulopathy, severe sepsis, or a combination of these factors. (Read the full article)

Neonatal follow-up programs are designed in part to identify developmental delays among high-risk infants after NICU hospitalization and make referrals to state-funded early intervention. Early intervention has been shown to benefit children with developmental delays.

Many high-risk infants demonstrating developmental delays at neonatal follow-up programs are not referred to early intervention. Subspecialty clinics share responsibility with the medical home in referring children from birth through three years with developmental problems to early intervention services. (Read the full article)

Although soy protein–based infant formula is known to support physical growth equal to that of infants fed cow's milk–based formula, data are lacking on developmental status of infants fed soy formula compared with breast milk or milk formula.

Infants fed soy protein–based formula scored within normal limits on standardized developmental testing and did not differ from infants fed cow’s milk–based formula. Breastfed infants have a slight advantage on cognitive development compared with formula-fed infants. (Read the full article)

New, effective approaches to obesity prevention are urgently needed. Social network interventions warrant our attention. Social networks play a significant role in adult and adolescent obesity. The role of social networks in pediatric obesity has not been examined.

Afterschool friendship ties play a critical role in setting physical activity patterns in children as young as 5 to 12 years. Children’s activity levels can be changed by the activity level of their social network during a 12-week afterschool program. (Read the full article)

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Our findings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to improve morbidity-free survival. (Read the full article)

There is a paucity of controlled studies of recombinant factor VIIa (rFVIIa) use for off-label indications in pediatric patients. Data on the use of off-label rFVIIa, including safety and efficacy, are mostly limited to case reports or small case series.

This is the largest reported case series of off-label rFVIIa in pediatric patients from a well-designed, representative, and rigorously audited registry of rFVIIa use and describes the indications for use, dose administered, adverse events, and outcomes in 388 patients. (Read the full article)

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

Preterm infants are at a high risk for retinopathy of prematurity (ROP). Several postnatal factors are well known to be associated with ROP. However, the relationships between antenatal or maternal risk factors and ROP are poorly understood.

This study used a large cohort database to study the influence of maternal gestational hypertension and preeclampsia on ROP in preterm infants. The results showed that preeclampsia, but not gestational hypertension, was associated with a reduced risk of ROP in preterm births. (Read the full article)

The causes of Perthes disease are unknown. There is considerable evidence that the disease has a vascular mechanism, although the nature of this is unknown. There is some suggestion that affected individuals may have a heightened cardiovascular risk in adulthood.

Children with Perthes disease have reduced vascular caliber, which is independent of body height, and abnormal functional vascular measures. These findings may be important in the mechanism of disease and may have implications on long-term vascular morbidity. (Read the full article)

Although many children are treated in general emergency departments, many such facilities have limited pediatric capabilities. Transfer to academic centers improves outcomes for critically ill patients, but transfers of noncritically ill children have not been well studied.

Although more than half of these patients are seriously ill, many transferred patients are discharged directly from the emergency department or are admitted for less than 24 hours. Orthopedic problems, gastrointestinal conditions, and traumatic head injury are the most common complaints. (Read the full article)

Previous cohorts of extremely low birth weight adolescents have assessed their health status similar to that of normal birth weight controls.

Extremely low birth weight adolescents born in the 1990s assess their health similar to controls but report less risk taking. Extremely low and normal birth weight children rate their health to be poorer at 8 than at 14 years. (Read the full article)

Adherence to guidelines has generally been shown to improve patient care and reduce the cost of care. Current understanding of the varying reasons why clinicians deviate from guidelines is based on surveys and retrospective reviews.

We examined clinician deviations from guidelines in a prospective fashion and attempted to categorize those deviations. Better elucidation of clinician reasoning behind deviations may inform care improvement and help define strategies to eliminate unjustifiable deviations. (Read the full article)

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a significant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling.

We provide the first nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socioeconomic factors and access to health care affect whether adolescents receive these services. (Read the full article)

Fetal factors that predispose infants to necrotizing enterocolitis (NEC) have been extensively studied. Maternal factors that may affect future risk for NEC are less clear.

We hypothesized that maternal factors were the primary cause of NEC. Through a case-control design we determined that maternal smoking predisposes infants to the development of NEC. Our results highlight the importance of smoking cessation in pregnancy. (Read the full article)

Group B Streptococcus (GBS) is a common cause of meningitis in young infants. Studies from the 1980s revealed that GBS meningitis resulted in substantial mortality and reported that survivors of the infection had a high likelihood of adverse neurodevelopmental outcome.

Contemporary long-term outcomes for children surviving GBS meningitis reveal that 56% are functioning normally. The remainder sustained mild-to-moderate (25%) or severe (19%) neurodevelopmental impairment, highlighting the need for GBS prevention and for ongoing developmental follow-up for GBS meningitis survivors. (Read the full article)

Children in foster care are at elevated risk for adverse outcomes. Placement instability and failure to achieve timely permanence exacerbate that risk. A handful of studies have found that parent-management training is effective in promoting placement stability and timely permanence.

Unlike parent-management training, youth focused interventions have not been systematically evaluated for their impact on placement and permanency outcomes. A mentoring and skills group intervention for preadolescents in foster care demonstrated better placement and permanency outcomes, especially for high-risk subgroups. (Read the full article)

Preterm children born between 29 and 36 gestational weeks are at higher risk of developmental delay. The Ages and Stages Questionnaires (ASQ) have been recommended as a developmental screening tool.

At 12 months’ corrected age (CA), the ASQ was insufficient in identifying delays on both mental and psychomotor scales of the Bayley Scales of Infant Development but was accurate in detecting mental delay at CA of 24 months. (Read the full article)

Known rates of nonsuicidal self-injury, hurting oneself without the intent to die, are between ~7% and 24% in samples of early adolescents and older adolescents, yet research has not reported rates for youth younger than 11 years old.

Children as young as 7 years old report engaging in nonsuicidal self-injury. There is a grade by gender interaction for nonsuicidal self-injury, such that ninth-grade girls report the greatest rates of engagement and do so by cutting themselves. (Read the full article)

There are limited cross-sectional data from observational studies of adolescents showing that regular participation in physical activity is associated with a higher quality of life status, whereas time spent in screen-based entertainment is associated with a poorer quality of life.

Adolescents who were physically active (particularly engaging in outdoor activity) over a 5-year period had higher quality of life than their less active peers. Conversely, high levels of screen-based entertainment over 5 years negatively affected quality of life status. (Read the full article)

Providers who speak Spanish, regardless of their proficiency level, may use Spanish for clinical care without seeking professional interpretation. Failure to use professional interpretation increases the risk for miscommunication and can lead to patient harm.

Providing residents with objective feedback on Spanish language proficiency decreased willingness to use Spanish in straightforward clinical scenarios. Language proficiency testing, coupled with institutional policies requiring professional interpretation, may improve care for patients with limited English proficiency. (Read the full article)

A wide variety of prescription drugs are prescribed to US children. Although one of the steps in assessing the risk/benefit of therapies in the pediatric population is to understand how they are used, pediatric drug utilization is not well characterized.

By using large prescription databases, this study examines the frequency and patterns of national outpatient drug utilization (acute and chronic medications) in US infants, children, and adolescents for 2002 through 2010. (Read the full article)

Parents are increasingly following alternative immunization schedules. Current studies suggest up to 21% of parents in the United States are intentionally delaying or refusing some or all of the recommended early-childhood vaccines.

This is the first study to use Immunization Information System data to quantify the proportion of children consistently delaying receipt of vaccines. Consistent-limiting children were found to have lower levels of recommended vaccines. (Read the full article)

Male circumcision reduces risk of HIV acquisition in men by 60% and is associated with other health benefits. Compared with adult circumcision, infant male circumcision is safer, less expensive, and represents a cost-saving intervention for HIV prevention in many settings.

IMC is little known in East Africa and is not routinely practiced. This is the first study to assess acceptability and uptake of IMC in East Africa among parents who were actually offered the procedure. (Read the full article)

Febrile infants in the first 90 days may have life-threatening serious bacterial infection. Well-appearing febrile infants with serious bacterial infections cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common.

The systemwide implementation of an evidence-based care process model for the care of febrile infants in Intermountain Healthcare was associated with increased delivery of evidence-based care, improved infant outcomes, and lower costs. This model adopted nationally can improve value. (Read the full article)

Infant malnutrition is known to be associated with behavioral and cognitive impairment throughout childhood, adolescence, and young adulthood. However, controlled studies addressing adult outcomes in middle life, including earning potential, educational attainment, and standard of living, are limited.

A discrete episode of moderate to severe malnutrition in infancy, with good rehabilitation thereafter, is associated with lower adult social status and a widening income gap relative to healthy controls, partially attributable to cognitive impairment in the previously malnourished. (Read the full article)

Neonatal hyperbilirubinemia may progress to bilirubin encephalopathy. Findings from previous studies on long-term development of neonatal hyperbilirubinemia are conflicting.

Using Ages and Stages Questionnaire, we observed no association between bilirubin exposure and overall development in 1- to 5-year-old children who in the neonatal period had total serum bilirubin level ≥25 mg/dL and no or only minor neurologic symptoms. (Read the full article)

Preterm infants from 33 gestational weeks can detect specific shape features (prism and cylinder) by touch (without visual control), and remember them; however, nothing is known about such abilities earlier in development.

The preterm infant, even when very immature (from 28 gestational weeks), is endowed with tactile sensory abilities: the exploration and memorization of an object by touch, the discrimination of a novel object, and the recognition of a familiar object after interference. (Read the full article)

Adherence to Pediatric Advanced Life Support resuscitation guidelines for children with sepsis is low; however, few studies have been conducted in the tertiary care emergency department setting.

Adherence to septic shock guidelines in a tertiary care pediatric emergency department is low. Adherence to fluid guidelines and the entire PALS algorithm was associated with a shorter hospital length of stay. (Read the full article)

Rotavirus vaccine efficacy is lower in low-income settings with the highest child mortality due to diarrhea. In recently published clinical trials of rotavirus vaccines in Africa, waning of efficacy was also noted among children aged ≥1 year.

These data offer the first evidence of the duration of protection of the pentavalent rotavirus vaccine against severe rotavirus disease after routine use of the vaccine in a developing country setting. (Read the full article)

Comprehensive lifestyle interventions for adolescent weight management, including diet, physical activity, and behavioral intervention, have been found to demonstrate modest, short-term success. However, very little is known about the long-term effectiveness of adolescent behavioral weight management trials.

This randomized controlled trial demonstrates that two 16-week group-based behavioral weight loss programs, when combined with either aerobic exercise or peer-based adventure therapy, produced sustained improvements in BMI among overweight/obese adolescents through 24 months. (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)

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)

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)

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)

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)

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)

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)

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)

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)

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)