Sleep disordered breathing (SDB) and behavioral sleep problems (BSPs) affect cognitive, behavioral, and language development. No studies have examined associations between SDB and BSPs across early childhood, and later special education need (SEN), on a population basis.

A history of SDB through 5 years of age was associated with ~40% increased odds of SEN at 8 years, among >11 000 children. BSPs were associated with 7% increased odds of SEN, for each additional ~12 months of reported BSPs. (Read the full article)

Little is known about how communication during pediatric asthma visits is associated with child control medication adherence 1 month after the visit.

When providers asked for caregiver input into the asthma treatment plan during the visit, caregivers reported significantly higher child medication adherence to control medications 1 month later. (Read the full article)

Previous studies suggest that abnormal findings on conventional EEG during the neonatal period are associated with death or severe brain injury in preterm infants. However, large cohort studies on preterm EEG for predicting later neurodevelopmental outcome remain scarce.

This study demonstrates precise prognostic values of conventional EEG for predicting neurodevelopmental outcome in the current perinatal care setting. Additionally, its prognostic values are independent of severe injury on neuroimaging and clinical risk factors. (Read the full article)

Pyloric stenosis is the most common condition requiring surgery in infants. It is typically not present at birth but develops within the first weeks after birth. The etiology is largely unknown, but bottle-feeding has been suggested as a risk factor.

This study demonstrated that bottle-fed infants had a 4.6-fold increased risk of developing pyloric stenosis compared with infants who were not bottle-fed. The result adds to the evidence supporting the advantage of exclusive breastfeeding in the first months after birth. (Read the full article)

Childhood obesity is a public health concern. Although determinants of childhood overweight have been identified and their effect sizes have been calculated, prevention as well as treatment have had limited success.

We have calculated the population-based relevance of determinants of childhood overweight by using attributable risks, which can be interpreted as maximum success rates of preventive measures. New concepts were applied to estimate the relative contribution of each risk factor. (Read the full article)

Declining dietary omega 3 polyunsaturated fatty acids has been associated with rising allergy prevalence and fish oil is therefore of interest in allergy prevention. Supplementation during pregnancy, but not after the age of 6 months, has achieved some allergy reductions.

We assessed the effect of fish oil supplementation from birth to 6 months, which has not been investigated previously. Our results, together with previous findings, will likely help define a "window of opportunity" for allergy intervention using fish oil supplements. (Read the full article)

Risk of preterm birth (PTB) has been noted to be higher for newborns with congenital heart defects (CHDs). The role of associated anomalies, whether PTB is spontaneous or medically induced, or specific categories of CHDs have not been elucidated.

By using population-based data, we found that PTB associated with CHDs was due to spontaneous PTB. Associated anomalies accounted for a small part of this increase, and there were specific associations between categories of CHDs and PTB. (Read the full article)

Rotavirus is a major cause of acute gastroenteritis among children worldwide. Vaccines targeting rotavirus have been demonstrated to be highly efficacious against severe disease in clinical trials and postlicensure studies. Vaccine impact on mild gastroenteritis has not been well studied.

We used a novel surveillance platform consisting of telephone triage data to capture mild gastroenteritis not detected in other surveillance systems. Since rotavirus vaccine licensure, gastroenteritis-related call proportions have declined, and peak gastroenteritis-related calls are correlated with community norovirus circulation. (Read the full article)

Critics argue that pediatric research without the potential for clinical benefit treats children as mere means to benefit others. Yet, there are no data to assess whether adolescents who participate in research, or their parents, agree with this view.

Respondents felt that by participating in research the adolescents were making important contributions to help others, and the adolescents felt proud to be doing so. These findings support the view that nonbeneficial pediatric research involves a type of charitable activity. (Read the full article)

The relationship between energy intake and obesity in children has yielded inconsistent results. Efforts to improve dietary intake as a means of improving weight status have largely yielded disappointing results.

Self-reported energy intake for younger, but not older, overweight/obese children is higher than healthy-weight peers. In early childhood, higher (or excessive) energy intake may lead to onset of obesity, but other mechanisms may be important to maintain obesity through adolescence. (Read the full article)

Changes in resident work hours are believed to have an impact on resident education and patient safety.

This study provides an understanding of the impact of changes in resident work hours on the staffing strategies of children’s hospitals. (Read the full article)

A 2001 survey of pediatric residency training directors indicated that few programs prepared residents to intervene on tobacco. A decade later, it is not known whether programs are doing more to prepare residents to intervene effectively with patients and parents.

Despite the need for pediatricians to play a leadership role in tobacco prevention and control, most pediatric residency training programs focus more on health effects of tobacco use and smoke exposure than on how to intervene with patients and parents. (Read the full article)

Fever phobia is a ubiquitous problem throughout the world. As a result, fever is pharmacologically overtreated, and medical attention is frequently sought by worried parents.

Most Canadian parents fear their child’s fever, resulting in aggressive surveillance and treatment. Parents expect information about fever etiology and how to care for their ill child. Few parents expect antibiotics and satisfaction with care is high. (Read the full article)

Iatrogenic medical errors are an important medical care issue in the United States. Errors may be particularly important in children with chronic health conditions, especially as the prevalence of chronic conditions is increasing in children.

In a nationally representative sample, we found that pediatric inpatients with chronic conditions were at a significantly higher risk for medical errors than inpatient children without chronic conditions, controlling for severity of illness, length of stay, and other potential confounders. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Few longitudinal studies from developing countries have assessed the relation between early maternal depressive symptoms and child growth beyond age 2. The results of these studies have been inconclusive.

Early maternal depressive symptoms were related to higher odds of deficits in stature but not to deficits in weight among preschool- and school-aged children. Well-child care provides opportunities to identify maternal depressive symptoms to prevent future child growth delays. (Read the full article)

Sending and receiving sexually explicit picture and text messages via cell phone (ie, "sexting") among adolescents is publicized as a societal and public health concern, yet it is unknown whether sexting is associated with physical sexual activity or sexual risk behavior.

This study is the first to examine sexting among a probability sample of adolescents and found that sexting is associated with sexual activity, sexual risk behavior, and knowing other person(s) who have sent a sext. (Read the full article)

Pediatric obesity is a prevalent public health issue that is associated with medical and physical consequences. Clinic-based interventions for pediatric obesity are effective, but they have limited reach and are costly.

This is the first examination of an empirically informed, scalable treatment of pediatric overweight and obesity delivered in YMCAs. The results indicate that a scalable, community-based pediatric obesity intervention can produce clinically meaningful changes in weight and quality of life. (Read the full article)

Findings from 3 studies suggest that the diagnosis of venous thromboembolism in hospitalized US children has increased in recent years.

This study provides additional evidence of an increasing trend in the rate of venous thromboembolism-associated hospitalization in US children, as well as a concurrent increase in the prevalence of venous catheter procedures. (Read the full article)

Overweight children are at risk for becoming obese adults, especially if they have an obese parent. Family-based behavioral interventions, largely implemented in specialized settings, have shown efficacy in weight control in youth aged ≥8 years.

This study demonstrates the efficacy of a family-based behavioral weight control program translated to be implemented in the primary care setting. The work underscores the importance of pediatricians intervening early and shifting their focus from the child to the family. (Read the full article)

The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure measurement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years. (Read the full article)

Expedited partner therapy (EPT) is an effective method of partner treatment of sexually transmitted infections but is not used frequently. There are limited data on provider knowledge, practices, and comfort with EPT use in adolescents.

California pediatric residents have knowledge gaps and discomfort providing EPT and presence of an adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Our findings support the need to improve EPT education in pediatric residencies. (Read the full article)

Most studies on corticoid treatment of respiratory syncytial virus (RSV) respiratory diseases have revealed no beneficial effect. The mechanism by which RSV respiratory-infected patients are insensitive to the antiinflammatory effect of corticosteroids is unknown.

This study helps to understand how a respiratory syncytial viral infection may alter the normal antiinflammatory response to cortisol and the insensitivity to glucocorticoid treatment. The increase expression of β glucocorticoid receptor could be a marker of disease severity. (Read the full article)

Despite numerous preventive strategies including prophylaxis with 400 IU/day of vitamin D in recent years, the deficiency of vitamin D in infants is still a global health problem.

This study reveals that the risk of vitamin D deficiency is high in exclusively breastfed infants, especially in winter, despite vitamin D supplementation. Therefore, it is suggested that an adjustment of vitamin D dosage for seasonal variation might be necessary. (Read the full article)

Inflammatory bowel disease pathogenesis is incompletely understood. Previous pediatric studies suggested associations between antibiotic use and inflammatory bowel disease development but were limited by recall bias, lack of controls, incomplete antibiotic capture, or included exposures between symptom onset and diagnosis.

Our population-based cohort study suggests that certain childhood antibiotic exposures are associated with an increased risk of developing inflammatory bowel disease. Our findings have implications for understanding the condition’s pathogenesis and provide additional stimulus for reducing unnecessary childhood antibiotic use. (Read the full article)

Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care.

This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. (Read the full article)

National data from child protective services agencies have shown a 55% decrease in the incidence of substantiated cases of physical abuse from 1992 to 2009, but no study has tracked the occurrence of serious injuries due to physical abuse.

Using national data from hospitalized children, we found a statistically significant increase in the incidence of serious injuries due to physical abuse from 1997 to 2009. These results are in sharp contrast to data from child protective services. (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)

The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.

The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting. (Read the full article)

Understanding human disease genomics requires large population-based studies. There is lack of standardization, as well as social and ethical concerns surrounding the consent process for pediatric participation in a biorepository.

The study identifies specific barriers to pediatric participation in biorepositories relative to adults, and proposes strategies to improve ethical and responsible participation of pediatric-aged patients in large-scale genomics and biorepository-driven research without significantly increasing research burden for affected families. (Read the full article)

Children investigated for alleged maltreatment have considerable physical, mental health (MH), developmental, and educational needs and often do not receive services to address these needs. The prevalence/correlates of MH services use in the current challenging financial environment is unknown.

This study demonstrates the importance of medical providers and schools for receipt of MH services for these children, but shows disparities in MH service use between white and nonwhite children. Unlike earlier findings, MH service use declined over the follow-up. (Read the full article)

Increased computed tomography (CT) use among adults and children presenting to emergency departments has spawned concern about associated radiation exposure. The risks and benefits of CT use for certain conditions, such as abdominal pain, among general pediatric populations remains unclear.

This study analyzes emergency department radiology trends between 1998 and 2008 among children with abdominal pain, highlighting a dramatic increase in CT use. Factors associated with CT ordering include older age, non-black race, and hospital admission. (Read the full article)

Retinal hemorrhages occur in accidental and inflicted traumatic brain injury (ITBI) and some medical encephalopathies. Large numbers and peripherally located retinal hemorrhages are frequently cited as distinguishing features of ITBI in infants, but the predictive value has not been established.

This prospective retinal imaging study found that a diagnosis of ITBI in infants and children can be distinguished from other traumatic and nontraumatic causes by the presence of >25 dot-blot (intraretinal layer) hemorrhages (positive predictive value = 93%). (Read the full article)

Invasive Cronobacter infection is a rare but devastating disease known to affect hospitalized premature or immunocompromised infants fed powdered infant formulas (PIFs). PIF labels imply that powdered formulas are safe for healthy, term infants if the label instructions are followed.

Cronobacter can also infect healthy, term infants in the first months of life, even if PIF label instructions are followed. Invasive Cronobacter infection is extremely rare in exclusively breastfed infants or those fed commercially sterile, ready-to-feed formulas. (Read the full article)

Among middle-aged adults, genotype scores predict incident type 2 diabetes but do not improve prediction models based on clinical risk factors including family history and BMI. These clinical factors are more dynamic in adolescence, however.

A genotype score also predicts type 2 diabetes from adolescence over a mean 27 years of follow-up into adulthood but does not improve prediction models based on clinical risk factors assessed in adolescence. (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)

Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.

Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article)

Concerns persist about sexual disinhibition after human papillomavirus (HPV) vaccination of preteenage girls. Self-reported surveys have indicated few anticipated behavior changes after HPV vaccination. Little is known about sexual activity–related clinical outcomes after HPV vaccination.

Utilizing managed care organization electronic data, we evaluated the incidence of adverse outcomes of sexual activity among vaccinated preteenage girls and found little difference between those who received HPV vaccine and those who did not. (Read the full article)

Oral health researchers and policy makers primarily use 4 national surveys to examine use of dental services among US children. Estimates from the surveys may vary, posing a challenge to population-based monitoring.

The authors of this study compared estimates of dental service use and delayed dental care obtained from 4 commonly used health surveys to appraise their utility for guiding pediatric oral health research and policy. (Read the full article)

Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder of presumed autoimmune or autoinflammatory etiology predominantly affecting children. There are limited data on the characteristics and optimal treatment of CNO in the United States.

A US-based cohort of pediatric CNO patients revealed high rates of personal and familial autoimmunity. Coexisting autoimmunity was a risk factor for widespread involvement. Response to nonsteroidal antiinflammatory drugs was inferior to that with immunosuppressive and biologic agents. (Read the full article)

Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.

US boys appear to be developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys. (Read the full article)

There are limited data on current testing and treatment patterns for children hospitalized with pneumonia, and on whether institutional guidelines affect care.

The use of institutional clinical practice guidelines was not associated with changes in diagnostic testing, hospital length of stay, or costs for children hospitalized with pneumonia, but was associated with increased use of narrow-spectrum antibiotics. (Read the full article)

Detained youth represent a vulnerable pediatric population with worse health outcomes than their nondetained peers. To date, little work has been done to determine whether health information technologies may be effectively used to improve the health of this underserved population.

The Internet is accessible to youth involved in the juvenile justice system. A securely accessible online system to store detained youth’s health information may be both feasible and acceptable for engaging these adolescents more actively in their health care. (Read the full article)

Social and environmental risks related to substandard housing contribute to adverse health outcomes. Partnerships between the health care and legal systems can help families address such risks and help clinicians understand the legal context of health.

A medical-legal partnership colocated in a pediatric primary care setting identified and treated a large cluster of poor quality, substandard housing. Housing improvements were possible because of strong collaboration between clinicians, attorneys, community partners, and families. (Read the full article)

Stress in parents has been shown to be related to child obesity.

The presence of multiple parent stressors was related to child obesity, and parent perception of stress was related to child fast-food consumption. Stress in parents may be an important risk factor for child obesity and related behaviors. (Read the full article)

The CPT1A p.P479L variant is common to northern aboriginal populations, leads to reduced enzyme activity, and may be associated with increased infant mortality rates.

The p.P479L variant is common in British Columbia First Nations with a coastal distribution correlated with regions of high infant mortality. Homozygotes display an altered acylcarnitine profile and are overrepresented in cases of sudden unexpected infant death in these areas. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) is commonly given to premature infants with nasal prongs and nasal masks. Prongs and masks appear to injure the nose of preterm infants with equal frequency.

Nasal masks are more effective than nasal prongs for preventing intubation and mechanical ventilation in premature infants within 72 hours of starting NCPAP. (Read the full article)

Autism spectrum disorders are characterized by heterogeneous severity. Previous latent variable analyses of longitudinal data have focused on trajectories of related features such as IQ, and not on changes over time in standardized, observational measures of core autism symptoms.

Autism Diagnostic Observation Schedule–calibrated severity scores allow comparisons of observational data from toddlerhood to adolescence. This first report of latent autism severity trajectory classes indicates that most children show stability in core symptom severity over many years; small groups improved or worsened. (Read the full article)

Postnatal growth restriction of preterm infants is a universal problem. Early "catch-up growth" has been associated with development of metabolic syndrome. In addition, preterm infants appear to be at major risk for developing increased adiposity and insulin resistance.

The consumption of a nutrient-enriched formula after hospital discharge may be beneficial in adequate for gestational age infants both in terms of head circumference growth and fat-free mass gain. (Read the full article)