Many population-based studies including pubertal children are based on self-assessment of pubertal maturation, the reliability of which is uncertain.

Self-assessment is not reliable for precise pubertal staging. Simple distinctions between prepuberty and puberty showed moderate agreement with clinical examinations. Parents and girls tended to underestimate and boys to overestimate pubertal development by up to 50% and 30%, respectively. (Read the full article)

Fasting insulin levels in childhood are increasingly being used as a surrogate for insulin resistance and risk of later type 2 diabetes, despite only a moderate correlation with whole-body insulin sensitivity and few data related to adult outcomes.

Elevated insulin values between the ages of 3 and 6 years are associated with an elevated risk for later type 2 diabetes. In 9- to 18-year-olds, elevated BMI (but not insulin values) is associated with later type 2 diabetes. (Read the full article)

Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine.

Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness. (Read the full article)

In 2009, only 58% of pediatricians were using electronic health records (EHRs), most of which were lacking pediatric functionality. The American Recovery and Reinvestment Act (ARRA) of 2009 accelerated the implementation of EHRs in pediatric offices.

The effects of ARRA have remained largely unmeasured in pediatrics. This study provides information on the prevalence and functionalities of EHRs, as well as physicians’ perceptions. (Read the full article)

Retrospective studies have shown that the majority of parents, independent of their country of origin, prefer a shared approach over a paternalistic approach or an informed approach when an end-of-life decision must be made for their children.

In actual conversations parents act in line with their preference for a shared approach. This behavior contrasts with the "some sharing" approach of physicians who carefully prepare parents for an end-of-life decision already being made by the medical team. (Read the full article)

Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion.

Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1–2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. (Read the full article)

Although pediatric professional guidelines emphasize addressing a child’s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families’ receipt of community-based resources.

This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families. (Read the full article)

Measles-containing vaccines are associated with several types of adverse events. Because measles-mumps-rubella-varicella (MMRV) versus separate measles-mumps-rubella (MMR) and varicella (MMR + V) vaccine increases a toddler’s risk for febrile seizures, we investigated whether MMRV is riskier than MMR + V and whether either vaccine elevates risk for additional safety outcomes.

Comparing MMRV with MMR + V, no increased risk of immune thrombocytopenia purpura, anaphylaxis, ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease was detected. No new safety concerns were identified after either vaccine, and most outcomes studied were unlikely after either vaccine. (Read the full article)

Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks’ gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated.

Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks’ gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. (Read the full article)

Meningococcal disease is a serious but rare infectious disease. In 2012, the incidence of meningococcal disease was at a historic low in the United States; however, incidence remained highest among infants aged <1 year.

This report describes the epidemiology and burden of meningococcal disease in infants aged <1 year in the United States and potential risk factors for transmission to this vulnerable group. These data are key to informing future meningococcal disease vaccination strategies. (Read the full article)

Light and intermittent smoking are harmful, but increasingly common, smoking patterns. It is unknown how adolescents perceive these smoking patterns, and whether these views differ by sociodemographic characteristics, and exposure to and use of tobacco.

US adolescents perceive light and intermittent smoking as significantly less dangerous than heavier smoking. One in 4 adolescents believes intermittent smoking causes little to no harm. Perceptions of relative safety were common among smokers. (Read the full article)

Both early and late introduction to gluten has been associated with increased risk for celiac disease (CD) and being breastfed at time of gluten introduction has been associated with a lower risk for CD.

In this prospective multinational study, time to first introduction to gluten-containing cereals is not an independent risk factor for developing CD, by a 5-year follow-up, neither on an overall level nor on country-level comparison. (Read the full article)

Bruising is common in young victims of physical abuse as well as in cases of accidental trauma. There is uncertainty regarding which young children with bruising require evaluation with skeletal survey for possible abuse.

The results of this study provide guidelines, based on the literature and knowledge of experts, for identifying children <24 months presenting for care in the hospital setting with bruises, who should and should not undergo skeletal survey. (Read the full article)

Administration of repeat doses of antenatal glucocorticoids to women at risk for preterm birth after an initial course reduces neonatal morbidity, without affecting rates of neurologic disability in early childhood. However, data on long-term effects on cardiometabolic health are limited.

Exposure to repeat doses of antenatal betamethasone did not increase cardiovascular risk factors at early school age. Clinicians wishing to use repeat antenatal glucocorticoids can be reassured that the risk of future cardiometabolic disease from this therapy is low. (Read the full article)

Pediatric obstructive sleep apnea syndrome (OSAS) has been associated with decreased health-related quality of life (QoL). Observational studies suggest that adenotonsillectomy for pediatric OSAS improves QoL, but these studies did not use a randomized study design or a control group of children with OSAS managed nonsurgically.

A prospective, randomized controlled study of adenotonsillectomy for pediatric OSAS showed significantly greater QoL and symptom improvements in children undergoing adenotonsillectomy than in the nonsurgical control arm. The extent of improvement was not appreciably influenced by baseline OSAS severity or obesity. (Read the full article)

Sleep apnea is a common condition in childhood, mainly managed by tonsillectomy. Codeine was recently contraindicated for pain management after surgery. Controversy exists regarding the safety and effectiveness of alternative medications, morphine, and ibuprofen.

Our findings suggest that ibuprofen does not increase tonsillar bleeding and in combination with acetaminophen is effective for pain management after tonsillectomy. Furthermore, standard morphine doses increased postoperative respiratory events and were not safe in all children. (Read the full article)

Menu labels depicting physical activity calorie equivalents may lead to ordering of fast food meals totaling fewer calories for adults. The effects of physical activity calorie equivalent labeling on parents’ fast food decisions for their children have not been examined.

Parents shown menus with any type of caloric content label may order fast food meals totaling fewer calories for their children. Menu labels showing physical activity equivalents may be more likely to influence parents to encourage their children to exercise. (Read the full article)

The number of nurse practitioner graduates in the United States has nearly doubled over the past 2 decades. However, the number of pediatric nurse practitioner (PNP) graduates has remained relatively flat, although the demand for PNPs is expected to increase.

This study estimates the best-case shortage of PNPs over the next 25 years. We propose possible policy interventions to address key areas of the PNP workforce system and we compute their impact on the forecasted PNP shortage. (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)

Current recommendations for the first outpatient visit for newborns are based on known health risks during the first week of life. Knowledge of the relationship between early well child visits and hospital readmissions may inform newborn health policy interventions.

Newborns who have a first well child visit within the recommended time period after hospital discharge are substantially less likely be readmitted. Obstacles to early follow-up should be addressed to reduce the risk of readmission in this population. (Read the full article)

Medical home transformation is led by practice-level assessment, but much of the evidence supporting the medical home derives from individual-level assessment based on parental perception. The association between these 2 levels of assessment is unknown.

Among Boston-area community health centers, there was no association between the individual- and practice-level assessments of the medical home. This highlights the need for studies supporting the child health benefits of medical home practice transformation. (Read the full article)

Universal use of conjugated pneumococcal vaccines has resulted in dramatic decline in vaccine-type invasive pneumococcal disease. However, disease is not evenly distributed, and children with underlying clinical conditions are disproportionately represented, especially among children >5 years of age.

Invasive pneumococcal disease among children with comorbidity results in higher morbidity and mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. (Read the full article)

Using large nationwide registers, we were unable to detect any association between augmentation of labor and ADHD in offspring. Our findings do not support a causal role of perinatal exposure to oxytocin during delivery on the development of ADHD. (Read the full article)

Accountable care organizations are expanding. In pediatrics, however, there is no information on cost savings or quality generated by such organizations.

Partners for Kids is a pediatric accountable care organization that increased value for Medicaid children in 34 Ohio counties, primarily through cost savings. This slowing in cost growth was achieved without diminishing the overall quality or outcomes of care. (Read the full article)

Obstructive sleep apnea syndrome (OSAS) is associated with significant comorbidity: behavioral problems, sleepiness, and impaired quality of life. However, the utility of OSAS symptoms versus polysomnography in the prediction of comorbidities or response to treatment is not well known.

Among children with OSAS, the Pediatric Sleep Questionnaire, a well-validated, simple 1-page symptom inventory, predicts key adenotonsillectomy-responsive OSAS comorbidities and their improvement after adenotonsillectomy. In contrast, polysomnographic results do not offer similar predictive value. (Read the full article)

Patients with sickle cell disease frequently express dissatisfaction with emergency department treatment of painful crises. Time to opioid administration has been suggested as a quality of care measure for painful crises.

Although not associated with hospital admission, time to opioid administration in sickle cell disease painful crises was associated with secondary outcomes including improvement between the first 2 pain scores, decreased pain score area under the curve at 4 hours, decreased emergency department length of stay, and increased total opioids. (Read the full article)

Noninvasive ventilation (NIV) reduced the need of intubation in preterm infants with RDS. However, randomized studies comparing nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure are still lacking.

The present study shows no differences in short-term outcomes between 2 different NIV strategies, nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure, in preterm infants for the initial treatment of RDS. (Read the full article)

Little is known about the mental health of extremely low birth weight survivors in their 30s. It is also unclear whether being born small for gestational age or being exposed to antenatal corticosteroids increases risk in this group.

In their 30s, extremely low birth weight survivors are less likely to have substance problems but are at elevated risk for other psychiatric disorders. Those born small for gestational age are at higher risk, but those exposed to antenatal corticosteroids are at the greatest risk of all. (Read the full article)

Worldwide prevalence estimates of Duchenne and Becker muscular dystrophies (DBMD) vary, likely due to differences in diagnostic criteria, ascertainment, and survival. To date, no population-based prevalence data for DBMD by race/ethnicity have been published in the United States.

Approximately 2 per 10 000 boys, ages 5 to 9 years, in 6 sites in the United States have DBMD; prevalence remained rather constant across 4 birth cohorts that spanned 2 decades. Prevalence differed among selected racial/ethnic groups across the time period examined. (Read the full article)

It is unclear whether developmental delays observed among infants with single-suture craniosynostosis (SSC) persist at school age. Few neurodevelopmental studies have examined children with SSC beyond age 3, with most having methodological limitations.

This study is the first to follow and test infants with SSC and a control group at school age. Infancy delays among children with SSC persisted at school age in some areas (IQ, math) but not others (reading, spelling). (Read the full article)

This is the first population-based study regarding the epidemiologic characteristics of pediatric zoster among only those who had contracted varicella.

The herpes zoster (HZ) incidence among only children with varicella infection is higher than previously reported. The HZ incidence increased for children contracting varicella aged <2 years. After a vaccination program, the HZ risk increased for those contracting varicella aged ≥2 years. (Read the full article)

Celiac disease (CD) may develop at any age. Young children with CD are at particular risk for malabsorption and failure to thrive. HLA-DR3-DQ2 homozygotes are at the highest genetic risk and develop CD very early in life.

Most children with CD detected in screening by 4 years of age have no symptoms and normal growth. Symptoms are unrelated to HLA genotype. Autoantibody levels correlate higher with severity of mucosal lesions in symptomatic as compared to asymptomatic children. (Read the full article)

Off-label prescription of inhaled nitric oxide (iNO) to neonates <34 weeks’ gestation has increased during the past decade. In early 2011, the National Institutes of Health determined that the available evidence did not support iNO use in this population.

Use of iNO among neonates <34 weeks’ gestation has increased since 2011, entirely from greater use in extremely preterm neonates. Off-label prescription of this drug now accounts for nearly half of all iNO use in American NICUs. (Read the full article)

Childhood bacteremia caused by vaccine-preventable organisms has substantially declined over the last decade. Recognition of bacteremia in children is difficult, and delayed administration of antibiotics is associated with poor outcomes. Adults with health care–associated Gram-negative bacteremia experience delays in receiving appropriate antibiotics.

Bacteremia in children presenting to the emergency department is increasingly health care associated and resistant to empirical antibiotics. These infections are associated with increased length of stay. Rates of Gram-negative bacteremia have increased, and children with Gram-negative bacteremia experience delayed antibiotic administration. (Read the full article)

Strategies are needed to engage families of chronically ill children at home in an ongoing process of shared decision-making regarding treatment that is responsive to families’ concerns and goals and children’s evolving symptoms.

This study evaluated a novel patient portal that facilitates shared decision-making in asthma. The portal was feasible and acceptable to families, improved outcomes, and provides a model for improving care through an electronic health record portal. (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)

Although there is evidence regarding comorbidity of physical and mental disorders from clinical samples of specific disorders and treatment registries, there is limited evidence from systematic samples of youth with comprehensive information on the full range of mental and physical disorders.

This report is the first study to investigate the specificity of associations between a broad range of mental and physical conditions by using a large, systematically obtained pediatric sample with enriched information from electronic medical records and direct interviews. (Read the full article)

Handheld echocardiography is a more portable and lower-cost alternative to standard echocardiography for rheumatic heart disease screening. Direct comparison of handheld echocardiography and auscultation for the detection of rheumatic heart disease has not been done previously.

Handheld echocardiography significantly improves detection of rheumatic heart disease compared with auscultation alone and may be a cost-effective screening strategy in developing countries. (Read the full article)

Existing literature discusses the unique medical and psychological needs of sex trafficking victims and highlights the importance of screening patients with risk factors. However, little is known about providers’ knowledge and confidence in their ability to provide care to victims.

The study summarizes the knowledge gaps and barriers providers face when assisting pediatric sex trafficking victims. It also highlights the impact of training on providers’ confidence and ability to appropriately care for victims. (Read the full article)

Topical corticosteroids are often used to treat atopic dermatitis (AD) in infants, although compliance is poor due to concerns over side effects. Pimecrolimus was shown to be a safe and effective noncorticosteroid treatment of AD in infants in short-term studies.

The Petite Study shows that long-term management of mild-to-moderate AD in infants with pimecrolimus or topical corticosteroids was safe without any effect on the developing immune system. Pimecrolimus had similar efficacy to topical corticosteroids and a marked steroid-sparing effect. (Read the full article)

Myxovirus resistance protein A (MxA) is a protein induced during viral infections. A few small-scale studies have suggested that MxA could be used as a marker of viral infection in clinical routine practice.

This study involves the largest patient population thus far and confirms the usefulness of MxA for diagnosing viral infections in children consulting the emergency department in a clinical routine setting. (Read the full article)

Subtherapeutic doses of antibiotics have been used as growth promoters in animal farming since the 1950s. Antibiotic exposure during infancy is associated with increased body mass in humans.

The weight-promoting effect of antibiotics is most pronounced when the exposure occurs at <6 months of age or repeatedly during infancy. Increased body mass is distinctly associated with exposure to cephalosporins and macrolides, especially in boys. (Read the full article)

Although the psychometric properties of the school-age Strengths and Difficulties Questionnaire (SDQ) have been extensively examined by using longitudinal data, the preschool version of the SDQ has only been explored in a limited number of cross-sectional studies.

This is the first psychometric study of the preschool SDQ using longitudinal data. We report measurement invariance over time, satisfactory reliability, construct and criterion validity, and predictive utility for subsequent behavioral problems (4 years) and clinical disorders (2 years). (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)

Sharing human milk between those with an abundant supply and those seeking milk for their child is growing in popularity, including that facilitated by Web sites established to link buyers and sellers.

This study documents that human milk purchased via the Internet can be contaminated with cow’s milk, which poses a potential risk to infants with allergy or intolerance to cow’s milk. (Read the full article)

Trainee success rates with infant lumbar puncture are poor. The model of just-in-time learning via simulation has produced clinical improvement for other medical skills such as cardiac compressions and central line dressing changes.

This is the first study to evaluate the impact of just-in-time-and-place simulation-based learning on success with infant lumbar puncture. The intervention improved clinical behaviors associated with success without making a significant impact on success with the procedure. (Read the full article)

Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated.

After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a cost-benefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias. (Read the full article)

Timely immunoprophylaxis and completion of the 3-dose hepatitis B vaccine series represents the cornerstone of perinatal hepatitis B prevention. Immunoprophylaxis for infants born to hepatitis B surface antigen–positive mothers reduces up to 95% of perinatal hepatitis B virus infections.

Despite recommended immunoprophylaxis, perinatal hepatitis B virus infection occurs among ~1% of infants. Infants born to mothers who are younger, hepatitis B e-antigen positive, or who have a high viral load or infants who receive <3 hepatitis B vaccine doses are at greatest risk of infection. (Read the full article)

Otorrhea is common in children with tympanostomy tubes: annually, 2 of 3 children develop 1 or more episodes. Antibiotic-glucocorticoid eardrops are the most effective treatment in both the short- and long-term.

Treatment with antibiotic-glucocorticoid eardrops costs less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea. Non–health care costs constitute a substantial proportion of the total costs of this condition. (Read the full article)

Considerable differences in outcome after extremely preterm birth have been reported between centers and regions providing a comparative level of care, but the reasons for these variations have been poorly examined.

In extremely preterm fetuses alive at the mother’s admission for delivery, and in infants born alive, mortality up to 2.5 years is reduced in regions with a more active use of perinatal interventions without increased neurodevelopmental morbidity. (Read the full article)