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)

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)

Most mothers in the United States do not meet recommendations for exclusive breastfeeding; however, little is known about how long mothers intend to exclusively breastfeed or how hospital practices affect achieving these intentions.

Most mothers who want to exclusively breastfeed intend to do so for ≥3 months, but the majority are not meeting their intended duration. Mothers are more likely to achieve their intended duration when their infant is not supplemented in the hospital. (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)

In 2011, the Accreditation Council on Graduate Medical Education increased restrictions on resident duty-hours. Further changes have been considered, including greater work-hour restrictions and lengthening residency. Residents’ views about these policies are unclear.

This is the first systematic, national inquiry into resident opinions on reduced work-hours and longer residency. More pediatric residents support than oppose reduced hours, and a minority would add a year to residency to achieve them. (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)

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)

Regular use of an integrated personal health record (PHR) may lead to improved outcomes through improved care coordination, communication, and patient empowerment. A limited number of studies have examined integrated PHR use for children.

Parents of children with chronic disease appear willing to use an integrated PHR to address health care needs for their child. PHRs may lead to improved health care and outcomes by enabling more coordinated care for children with chronic disease. (Read the full article)

Previous studies show beneficial effects of cycled lighting in neonatal care on infant day–night activity, sleep behavior, and postnatal growth. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend neonatal care under cycled lighting conditions.

This study found that cycled lighting during neonatal care reduces infant’s fussing and crying behavior at 5 and 11 weeks’ corrected age and improves growth during neonatal period. These findings support the introduction of cycled lighting in neonatal care practice. (Read the full article)

Early speech and language delays are risk factors for later developmental and social difficulties. It is easier to identify them retrospectively than prospectively. Population characteristics and prevalence rates make screening problematic.

Using data from a birth cohort, this study identifies predictors of language performance at 5 years and 4 patterns of change between 3 and 5 years, comparing those who change with those whose profile remains low across time points. (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)

Children with a single kidney are often counseled to avoid contact/collision sports based on the concern of injury to the kidney; however, the incidence of kidney injury during sport is not well understood.

Based on this multiyear, prospective injury surveillance system of varsity-level high school athletes, sport-related kidney injury is rare. Reevaluation of American Academy of Pediatrics recommendations regarding sport participation by children with a single kidney is indicated. (Read the full article)

Emphasis on preventing central line-associated bloodstream infections (CLABSIs) in US health care facilities and prophylactic antifungal medication use in neonates may impact incidence of Candida spp. CLABSIs. However, data on trends in incidence of neonatal Candida spp. CLABSIs are lacking.

Data from a large sample of US NICUs was analyzed to assess trends in incidence over time. This analysis provides a description of the epidemiology of Candida spp. CLABSIs in a national health care-associated infections surveillance system. (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)

Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data are available on the frequency, severity, and circumstances of reactions and caretaker medical response.

This study describes food allergy reaction frequency, circumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental allergen feeding, and underutilization of epinephrine for severe reactions. (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)

Family-centered rounds (FCR) show promise for higher patient care satisfaction. Many previous studies are limited by small sample size and observational or pre-post designs, and health care service outcomes have not been previously examined.

Our study uses an FCR assessment tool and a comparison group of non-FCR patients. We found that FCR are associated with improved family experiences, with no additional burden to health care service use. (Read the full article)

Among adolescents, weight status has been inversely associated with sports participation but not active commuting or physical education. Studies of each form of physical activity have not included adequate adjustments for other physical activities, previous body weight, or diet quality.

Estimates indicate overweight/obesity and obesity prevalence would decrease by 11% and 26%, respectively, if adolescents played on at least 2 sports teams per year; obesity prevalence would decrease by 22% if adolescents walked/biked to school 4–5 days per week. (Read the full article)

Sudden infant death syndrome remains the major cause of postneonatal death in developed countries. Although infant-parent bed-sharing following antenatal smoking or maternal consumption of alcohol on the bed-sharing night increases the risk of death, the mechanism is not known.

Bed-sharing infants experienced more oxygen desaturations and episodes of carbon dioxide rebreathing than cot-sleeping infants but showed appropriate behavioral and physiologic responses. A deficit in these responses in vulnerable infants could link to increased risk of sudden infant death syndrome. (Read the full article)

Many drugs are not approved for use in pediatric patients and there is limited evidence on their safety and efficacy in children. Furthermore, there is concern that the quality of pediatric trials is inferior compared with adult trials.

For conditions with a high disease burden in children, only a small proportion of clinical drug trials study pediatric patients. Most pediatric trials are not funded by industry, and the deficiency of evidence is largest in developing countries. (Read the full article)

The American Academy of Pediatrics prioritized detection of mental illness in children presenting to emergency departments (ED) by using standardized clinical tools. Only a minority of ED physicians indicate that they use evidence-based screening methods to assess mental health concerns.

This study presents the psychometrics of the HEADS ED (home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources), a brief, standardized screening tool for pediatric EDs. This tool ensures key information is obtained for decision-making, determining acuity level, and areas of need. (Read the full article)

Food insecurity has been linked to childhood obesity in a number of studies. Few studies have explored potential pathways through which food insecurity is related to child weight, especially in low-income families with young infants.

We found that food insecurity was related to maternal controlling feeding styles and concerns about the infants’ future weight. Early obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure. (Read the full article)

Children with obstructive sleep apnea (OSA) are usually treated by surgical removal of their upper airway lymphadenoid tissue. Recently, medications were offered to patients with nonsevere OSA. Montelukast, for this indication, had never been studied in a randomized controlled manner.

Montelukast effectively reduced polysomnographic findings, symptoms, and the size of the adenoidal tissue in children with nonsevere OSA. The findings support the potential of a leukotriene modifier as a novel, safe, noninvasive alternative for children with mild to moderate OSA. (Read the full article)

Since the introduction of effective vaccines in the United States, the incidence of invasive Haemophilus influenzae type b (Hib) disease in children aged <5 years has decreased by 99%. In 2007, in response to limited vaccine supply, Hib booster doses were deferred for 18 months.

This review found no significant change in the incidence of invasive Hib disease in the United States during the booster dose deferral period, suggesting that booster dose deferral is a reasonable approach to Hib vaccine shortages in the short-term. (Read the full article)

Childhood obesity is already prevalent by preschool age, particularly among Latinos. Parents have tremendous influence on factors that contribute to childhood obesity (eg, diet, physical activity); thus, family plays a crucial role in pediatric obesity prevention.

This randomized controlled trial examined the effect of a behavioral intervention involving Latino-American parent–preschool-aged child dyads. The intervention resulted in reductions in absolute BMI across the 3-month study period, with patterns suggesting the largest effect for obese children. (Read the full article)

Vitamin D is a pleiotropic hormone important for proper functioning of multiple organs. Adult critical care studies have suggested vitamin D as a modifiable risk factor. No studies have investigated the prevalence, risk factors, or role in pediatric critical illness.

This study provides evidence that the majority of critically ill children have vitamin D deficiency at the time of PICU admission, and that lower levels are associated with hypocalcemia, catecholamine administration, significant fluid bolus requirements, and longer PICU admissions. (Read the full article)

Honey is recommended as a cough medication by the World Health Organization. To date, the efficacy of this treatment has been shown in 2 studies: one tested only buckwheat honey and the other study was not blinded.

In a randomized controlled trial, we compared 3 types of honey versus placebo as a treatment of upper respiratory tract infection–associated cough. These types of honey were superior to placebo in alleviating cough. (Read the full article)

Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children.

This study demonstrates that a healthy media use intervention can improve child sleep outcomes and adds evidence that the relationship between media and sleep in preschool-aged children is indeed causal in nature. (Read the full article)

Loud snoring, which spikes at ~2 to 3 years of age, has been associated with behavior problems in school-aged children in cross-sectional studies, but no longitudinal studies have quantified predictors and the behavioral impact of persistent snoring in preschool-aged children.

Persistent loud snoring, which occurs in 9% of children 2 to 3 years of age, is linked with behavior problems. Higher socioeconomic status and a history of breastfeeding were associated with lower rates of transient and persistent snoring in young children. (Read the full article)

Ideal empirical antibiotic choices are based on local susceptibility data. These choices are important for ensuring positive patient outcomes, but pediatric-specific data may not be available.

Antibiotic susceptibilities differ by age group within a tertiary-care hospital. Knowing these differences, pediatricians chose empirical antibiotic therapy more likely to be successful. Children with infectious diseases would benefit from reporting of pediatric-specific susceptibility results. (Read the full article)

Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.

This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)

Computerized provider order entry (CPOE) has been recognized to enhance the efficiency, safety, and quality of medical work. Yet vendors and organizations have not determined best practices for customizations, resulting in systems that have poor usability and unintended consequences of use.

This study demonstrated that systematically developed order sets reduce cognitive workload and order variation in the context of improved system usability and guideline adherence. The concept of cognitive workload reduction is novel in the setting of computer order entry. (Read the full article)

There is evidence from both developed and developing countries that antiretroviral treatment significantly reduces mortality in HIV-infected children. However, in sub-Saharan Africa, numerous health system, financial, and human resource obstacles make delivering quality pediatric HIV care a challenge.

We describe the experience of the Baylor International Pediatrics AIDS Initiative in Malawi, Lesotho, and Swaziland. Despite challenges delivering pediatric treatment in these countries, mortality and clinical outcomes approaching those from developed countries are feasible. (Read the full article)

Immunization recall systems have been found effective in increasing immunization rates in younger children and adults; however, there have been only a few studies in adolescents and they have produced mixed results.

In this randomized controlled trial, immunization rates were significantly higher 4 weeks after a recall intervention in which both the adolescent’s parents and the adolescent were contacted, but this effect did not persist 1 year after the intervention. (Read the full article)

Micronutrients are essential for brain development during gestation and infancy. Few randomized trials of maternal multiple micronutrient supplementation during pregnancy and postpartum have examined child outcomes beyond the neonatal period or tested which cognitive domains show long-term effects.

Children of undernourished mothers given multiple micronutrients performed as well as children of well-nourished mothers in motor and visual attention/spatial ability at age 42 months; children of undernourished mothers given iron/folic acid showed 4- to 5-month delays in these abilities. (Read the full article)

The outcome of status epilepticus in children depends on the etiology. In otherwise normal children who have ≥1 episodes of unprovoked status epilepticus as part of the evolution of their epilepsy, the seizure and intellectual outcome is unclear.

Based on population-based data and 20 to 30 years’ follow-up of normal children with focal epilepsy, one-third with status epilepticus had recurrence of status. Reassuringly, intelligence, seizure control, and rate of remission were not altered compared with those without status epilepticus. (Read the full article)

Materialism and life satisfaction are known to be associated with each other. Research among adults has shown that materialism and life satisfaction negatively affect each other, leading to a downward spiral.

In contrast to research conducted among adults, no longitudinal effect of materialism on life satisfaction was found for 8- to 11-year-olds. However, life satisfaction did negatively affect materialism, but only for children who were frequently exposed to advertising. (Read the full article)

The importance of and interest in childhood mental problems have increased worldwide. There are few population studies on child and adolescent mental health and health-related quality of life (HRQoL).

A social gradient was found in childhood mental health according to maternal education level and social class, but none was found in HRQoL, although children from disadvantaged social classes had somewhat lower HRQoL scores than their more advantaged counterparts. (Read the full article)

A growing number of epidemiologic studies suggest that individuals with lower vitamin D levels are at higher risk of acute respiratory tract infection. Randomized controlled trials are needed to determine if vitamin D supplementation would decrease this risk.

In a randomized controlled trial of 247 Mongolian children with vitamin D deficiency in winter, with double-blinding and 99% follow-up, vitamin D supplementation significantly reduced the risk of acute respiratory tract infections. (Read the full article)

Early life nutrition may program pubertal timing. Limited evidence suggests breastfeeding is associated with later puberty and childhood milk consumption with earlier puberty; whether these observations are biologically mediated or confounded by socioeconomic position is unclear.

In a developed non-Western setting with little socioeconomic patterning of pubertal timing, neither breastfeeding nor childhood milk consumption was associated with pubertal timing, suggesting nutritional exposures during potentially critical periods may not have long-term effects on rates of maturation. (Read the full article)

The higher the predischarge bilirubin percentile reading on the hour of life–specific nomogram, the higher becomes that infant's risk of developing significant hyperbilirubinemia. Neonates in the low-risk zones (≤75th percentile) have a low risk of developing hyperbilirubinemia.

Thirty-two percent of newborns readmitted for hyperbilirubinemia had low-risk zone predischarge bilirubin percentile values, predominantly in the intermediate low-risk zone (41st–75th percentile). The intermediate low-risk zone may not be as low risk as previously thought. (Read the full article)

Skills learned in standardized courses are estimated to last only a few months. Neonatal Resuscitation Program certification is mandatory for all pediatric residents and is valid for 2 years. Exact timing of when proficiency is lost is unknown.

Neonatal Resuscitation Program skills deteriorate immediately after certification, whereas knowledge is better retained. Significant skill deficits were seen at baseline raising concerns regarding the efficacy of the current course structure. Discrepancies in knowledge and skill retention may impact caregiver performance. (Read the full article)

Skin-to-skin contact with mothers and fathers has been associated with lower pain reactivity and enhanced physiologic recovery after heel lance. The effect of skin-to-skin contact between preterm twins during cobedding on pain response has yet to be studied.

We demonstrate that cobedding significantly diminished time to recovery in preterm twins after heel lance but did not lower pain reactivity. (Read the full article)

The 2009 influenza A (H1N1) pandemic caused illness in all age groups, but children were disproportionately affected. Children with underlying neurologic disorders were at high risk of influenza-related complications, including death.

This study provides the first detailed description of underlying neurologic disorders among children who died of influenza A (H1N1)pdm09 virus infection. (Read the full article)

Although several studies have demonstrated increased morbidity and mortality with pH1N1 in children, others have found its clinical course to be similar to seasonal influenza. Moreover, most studies were conducted at single centers, thus raising concerns about generalizability of findings.

This analysis provides national-level active hospital-based surveillance data comparing pH1N1 with 5 previous years of seasonal influenza A and demonstrates differences in risk factors and clinical presentation but not in ICU admission or mortality. (Read the full article)