The 1-dose childhood varicella vaccination program in the United States resulted in dramatic declines in varicella incidence, hospitalizations, and deaths. There is little information on the impact of the 2006 recommendation for 2-dose varicella vaccination of children on varicella epidemiology.

In the first 5 years of the 2-dose varicella vaccination program, declines in varicella incidence were seen in all age groups, including infants who are not eligible for varicella vaccination, providing evidence of the benefit of high population immunity. (Read the full article)

Research has focused on primarily white parents, months to years after their infant/child or adult child died of cancer, accidental injury, sudden infant death syndrome, or suicide. Many parents experience depression and/or posttraumatic stress disorder and greater risk for some physical health problems.

Data on hospitalizations, changes in and management of chronic conditions, complexity of medication regimens, depression, and posttraumatic stress disorder were collected over 13 months from 249 Hispanic, black, and white parents in 188 families who experienced an infant/child NICU/PICU death. (Read the full article)

Pneumonia is the leading cause of death in young children worldwide. Anemia, widely prevalent globally, is not routinely assessed when treating pneumonia. The effect of anemia and high altitude on outcome of pneumonia is not well described.

Anemia at high altitude increases the risk of poor outcome with severe pneumonia. Children with severe pneumonia at high altitude present with more severe hypoxemia and have a longer time to recovery than children at low altitude. (Read the full article)

A large and growing literature has demonstrated significant associations between the use of spanking and later child aggression, but we know less about paternal spanking, effects of spanking on cognitive development, and longer-term effects.

Accounting for a broad array of risk factors, spanking predicts both aggression and receptive vocabulary across the first decade of life. Importantly, we include paternal spanking, cognitive outcomes, and a longitudinal span longer than that of much of the literature. (Read the full article)

Several studies have shown that behavioral problems can be associated with defecation and voiding disorders, although few studies have looked directly at a link between a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and constipation or fecal incontinence.

We identified an increased risk for both constipation and fecal incontinence in children with ADHD. In patients with concomitant ADHD and defecation disorders, more aggressive medical and behavioral treatment of the constipation or fecal incontinence may be warranted. (Read the full article)

Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders.

Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy. (Read the full article)

Unintentional overdose and emergency department visits secondary to nonmedical use of prescription drugs are on the rise with peak age of onset in midadolescence for these risk behaviors. Also, risk behaviors, such as substance use and violence, tend to cluster.

Approximately 1 in 10 adolescents or young adults using the emergency department endorse nonmedical prescription opioid or sedative use in the past year. Rates of current opioid or sedative prescriptions are low among this group. (Read the full article)

As more children with sickle cell disease survive into adulthood, they are increasingly hospitalized in both children’s and general hospitals and managed by different provider specialists. But it is unknown if hospital type and provider specialty affect patient outcomes.

Using a large national administrative dataset, this study revealed that general hospitals were associated with higher rates of intubation and longer lengths of stay compared with children’s hospitals for adolescents and young adults with SCD admitted with acute chest syndrome. (Read the full article)

Previous studies have found links between prepregnancy BMI and/or pregnancy weight gain and autism spectrum disorders (ASD) risk. Several contributing factors to BMI and pregnancy weight gain (ie, prematurity, advanced maternal age, parental education, and parity) overlap with established ASD risk factors.

This study identifies an association between ASD risk and prenatal weight gain, but not prepregnancy BMI, and accounts for important confounding variables excluded in previous analyses. It provides the first within-mother comparison of these factors by including unaffected sibling controls. (Read the full article)

Influenza-associated deaths in children occur every year among children of all ages. Young children and those with high-risk medical conditions are at higher risk of influenza-related complications.

This study describes influenza-associated pediatric deaths over 8 influenza seasons in the United States and compares characteristics of deaths in children with high-risk medical conditions with those in children without high-risk medical conditions. (Read the full article)

Some studies suggest a contribution of environmental exposures such as pesticides to risk of hypospadias, whereas others do not. One of the challenges that has limited current knowledge is the lack of detailed exposure data.

This study examined a more detailed assessment of exposure to pesticides than previous studies. Exposure assignments, whether to groups of chemicals, specific chemicals, or a composite involving a number of chemicals, showed a general lack of association with hypospadias. (Read the full article)

It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child’s risk for specific adverse health outcomes.

By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors. (Read the full article)

An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child’s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.

How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination. (Read the full article)

NF1 is the commonest single-gene neurodevelopmental disorder with known neurobiology and developmental impact on attention and cognition. Its impact on social functioning is described but poorly understood, with no population-based study of autism spectrum disorder (ASD) prevalence in the disorder.

This epidemiological study shows high prevalence of 25% ASD in NF1 not explained by learning difficulties. ASD should be considered during clinical practice with NF1. Further research into NF1 as a single-gene model of ASD is warranted. (Read the full article)

Several studies have documented earlier onset of pubertal maturation in girls, with several potential factors attributed to the earlier onset.

This study demonstrates earlier maturation in white non-Hispanic girls, with greater BMI linked as a major factor. The entire distribution of pubertal timing has shifted to a younger age, suggesting redefinition of ages for both early and late maturation. (Read the full article)

Certain characteristics of the sleep environment increase the risk for sleep-related, sudden, and unexplained infant death. These characteristics have the potential to generate asphyxia. The relationship between the deaths occurring in these environments and neurochemical abnormalities in the brainstem that may impair protective responses to asphyxia is unknown.

We report neurochemical brainstem abnormalities underlying cases of sudden infant death that are associated with and without potential asphyxial situations in the sleep environment at death. The means to detect and treat these abnormalities in infants at risk are needed. (Read the full article)

Global health is of increasing interest and relevance to North American pediatric trainees. Opportunities for resident global health training and exposure are most often limited to electives or trainees in dedicated global health tracks.

A series of short, structured, participatory global child health modules improved knowledge and were well received and integrated within academic programs. Such modules enable global health learning for all residents, including those who never intend to practice overseas. (Read the full article)

Bacteremia occurs in 2.2% of febrile infants who have a blood culture drawn. Regional data suggest that Escherichia coli, group B Streptococcus, and Staphylococcus aureus are leading causes; however, the geographic boundaries of these data limit universal applicability.

This is the first national study examining epidemiology of bacteremia in febrile infants admitted to a general inpatient unit. The most common pathogens were Escherichia coli (42%), group B Streptococcus (23%), and Streptococcus pneumoniae (6%). No Listeria monocytogenes was identified. (Read the full article)

Prenatal and postnatal organophosphate (cholinesterase inhibitor) pesticide exposure has been associated with delays in attention, memory, intelligence, and inhibitory control. Two recent studies reported decreased attention and working memory with greater exposure to organophosphates in boys but not in girls.

This is the first study to report associations between decreased acetylcholinesterase activity, a stable marker of cholinesterase inhibitor pesticide exposure, and lower overall neurodevelopment, attention, inhibitory control, and memory. These associations were present in boys but not in girls. (Read the full article)

Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.

In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development. (Read the full article)

Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease, resulting in morbidity. Magnesium is a vasodilator and has been shown to improve red blood cell hydration. Previous small studies have suggested that treatment with magnesium may decrease VOEs.

Intravenous magnesium sulfate is well tolerated in relatively high doses but had no effect on the length of stay in hospital, pain scores, or cumulative analgesia used in children admitted with painful VOEs in sickle cell disease. (Read the full article)

Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors.

The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. (Read the full article)

One study examined the incidence of obesity among low-income children aged <5 years who participated in federally funded child health and nutrition programs during 1985–1990. The study examined the variations by baseline age but not by gender or race/ethnicity.

This study provides most recent data on incidence and reversing of obesity and variations across gender, baseline age, and racial/ethnic subgroups among young low-income children. We conducted multivariable analyses to examine the relative risk of obesity in population subgroups. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health condition diagnosed in childhood, is highly heritable, and more common in boys. Although studies have identified perinatal risk factors, no one has investigated perinatal risk factors separately in boys and girls.

Contrary to other studies, low birth weight, postterm pregnancy, low Apgar scores, and fetal distress were not risk factors for ADHD irrespective of gender. Early term deliveries increased the risk of ADHD, and oxytocin augmentation in girls may be protective. (Read the full article)

Bronchiolitis is a leading cause of hospitalization for children, yet variability in its management persists. To promote evidence-based care, the American Academy of Pediatrics published practice guidelines in 2006 that advocate primarily supportive care for this self-limited disease.

Since publication of the guidelines in 2006, few studies have evaluated their impact on diagnostic testing and treatment. This study documents positive changes in resource use among hospitalized patients with bronchiolitis over an 8-year period. (Read the full article)

The demand for donor kidneys for transplantation exceeds supply. En bloc kidney transplantation and donation after determination of circulatory death from pediatric donors increases the potential donor pool.

Newborn infants undergoing elective withdrawal of life support in the NICU are a previously unrecognized source of potential kidney donors. (Read the full article)

Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders.

Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. (Read the full article)

Fewer clinical trials are performed in children compared with other patient populations. It is unknown how well existing pediatric clinical trials are aligned with the needs of children, both in high-income countries and globally.

There is only moderate correlation between clinical trial activity and pediatric burden of disease, with certain conditions substantially underrepresented in the current research portfolio. Our findings provide a benchmark for prioritizing conditions for study, analyzing gaps, and identifying funding priorities. (Read the full article)

Studies assessing the accuracy of brief screening tools for postpartum depression have been conducted among adult women; however, no similar validation studies have been conducted among adolescent mothers. Accurate and valid brief depression screening tools are needed for adolescent mothers.

We found that the 10-item Edinburgh Postnatal Depression Scale (EPDS) and 2 subscales, the EPDS-7 and EPDS-2, are highly accurate at identifying postpartum depression among adolescent mothers. In pediatric settings with limited time and resources, these brief scales have potential to be used as effective depression screening tools. (Read the full article)

Early adiposity rebound is associated with future obesity and an increased risk of development of type 2 diabetes and coronary heart disease in adult life.

This study shows that early adiposity rebound is associated with future obesity and metabolic consequences of higher triglycerides, atherogenic index, apolipoprotein B, and blood pressure and lower high-density lipoprotein cholesterol at 12 years of age. (Read the full article)

Studies have shown dysfunction in the baroreflex mechanism and the autonomic nervous system, particularly in the sympathetic nervous system, in the pathophysiology of chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and syncope.

Vitamin B₁₂ deficiency is associated with postural orthostatic tachycardia syndrome in adolescence. (Read the full article)

Currently, the false-positive rate of appendicitis in children is ≤5%. Abdominal imaging and blood tests (particularly leukocytosis) help minimize the negative appendectomy rate, but appendicitis is not always associated with an elevated white blood cell count.

Reducing the threshold of leukocytosis as a criterion for appendicitis to 8000 to 9000 white blood cells per µL improves specificity (negative appendectomy: <1%) while only marginally decreasing sensitivity. (Read the full article)

Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.

We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years’ corrected age. (Read the full article)

Due to reports of unintentional overdoses, in 2011 the US Food and Drug Administration finalized voluntary recommendations for dosing devices included with over-the-counter (OTC) liquid medications. The Consumer Healthcare Products Association previously endorsed similar recommendations for devices and dosing directions.

This study assessed dosing directions and devices for national brand name OTC liquid medications, available after a voluntary FDA guidance, and found high levels of adherence to most recommendations. Further improvement efforts should prioritize recommendations directly addressing potential dosing errors. (Read the full article)

Warnings of increased risk for suicidality have been placed on antidepressant medications. Because antidepressants differ in their characteristics, including effects on neurotransmitters, it is possible that the risk of suicidal behavior for individual medications may differ.

In a cohort of 36 842 children with review of medical records for confirmation of suicide attempts, we found no difference for risk of suicide attempts among individual medications compared with fluoxetine, the currently recommended antidepressant for treatment of depression. (Read the full article)

Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated.

A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems. (Read the full article)

Childhood obesity poses a serious threat to human health. Obesity is caused by genetic and environmental factors and linked to type 2 diabetes and cardiovascular disease. Pediatric obesity cohorts aim at understanding early events in the pathophysiology of obesity-related complications.

Cohort subjects are examined at consecutive visits, including measurements of glucose tolerance and hormones regulating nutrient handling (enhanced glucose tolerance tests) and body composition (MRI and bioimpedance). Mechanisms causing obese children to progress to type 2 diabetes are delineated. (Read the full article)

Injuries sustained by children in the school setting have a significant public health impact. A concerning subgroup of school injuries are due to intentional and violent etiologies. Several studies have identified a need for further research to understand intentional school-based injuries.

This study discusses national estimates and trends over time and risk factors of intentional injury–related emergency department visits due to injuries sustained in the school setting. (Read the full article)

Shoulder injuries are common among high school athletes. These injuries, both traumatic and overuse, contribute to significant time loss from athletic activity. Understanding sport-specific injury patterns is critical for development of targeted injury prevention programs.

This study is the most comprehensive analysis of high school shoulder injuries to date, providing national injury estimates while examining injury rates, diagnoses, severity, and mechanisms of injury in 9 interscholastic sports. (Read the full article)

Major depression is common among adolescents. The PHQ-9 has good sensitivity and specificity for detecting depression among adolescents in primary care settings. However, no study has examined the psychometric properties of the PHQ-9 among Chinese adolescents in school settings.

This is the first study to validate the use of the PHQ-9, Patient Health Questionnaire–2 item, and Patient Health Questionnaire–1 item among Chinese adolescents in Taiwan. The PHQ-9 and its 2 subscales have good sensitivity and specificity for detecting depression among school adolescents. (Read the full article)

The incidence of invasive candidiasis in hospitalized infants is related to postnatal exposures, but large-scale studies relating the incidence of invasive candidiasis to changes in exposures over time are not available.

This study describes the association between the incidence of invasive candidiasis and changes in use of antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotics over time. (Read the full article)

An algorithm for neonatal early-onset sepsis risk based on Centers for Disease Control and Prevention 2002 guidelines for prevention of perinatal Group B Streptococcus disease results in the evaluation of ~12–15% of well-appearing term and late preterm infants.

A revised algorithm based on the Centers for Disease Control and Prevention 2010 guidelines eliminated 25% of all early-onset sepsis evaluations and resulted in significant cost savings, without short-term evidence of harm. (Read the full article)

Recommended management of febrile neonates (≤28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments.

There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations. (Read the full article)

The Centers for Disease Control and FITNESSGRAM BMI percentile thresholds are commonly used for obesity screening in youth. It is assumed that these thresholds are predictive of metabolic health risk, but little diagnostic data are available.

Both thresholds are predictive of metabolic syndrome, more so for boys than for girls, although with differing sensitivity and specificity. The diagnostic details of the thresholds can inform clinicians and practitioners about how these standards perform in practice. (Read the full article)

Children with congenital heart disease demonstrate a high prevalence of low-severity developmental problems in the areas of language, motor skills, attention, and executive function. Systematic evaluation has been recommended to promote early detection of problems and ensure appropriate intervention.

This study presents results of longitudinal testing in early childhood. Developmental delays were common. Feeding difficulty and medical and genetic comorbidities increased risk for delays. Exposure to risk and prevalence of delay change over time; therefore, repeated evaluations are warranted. (Read the full article)

Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neurodevelopmental impairment in full-term infants. The incidence of congenital CMV infection in preterm infants and the possible associations with developmental outcomes are unknown.

This study defines the incidence of congenital CMV infection in very low birth weight infants and identifies strong associations of congenital CMV infection with hearing loss and adverse neurodevelopmental outcomes in this population. (Read the full article)

It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.

This is the first study to provide evidence that preterm infants’ exposure to adult words in the NICU before the mother’s due date are associated with better cognitive and language outcomes at 7 and 18 months’ corrected age. (Read the full article)

More than 60% of all US tuberculosis cases occur among foreign-born persons, but ~90% of cases in young children occur among US-born; many of these children have foreign-born parents, suggesting that this is an important population for prevention.

This is the first study to calculate tuberculosis rates in US-born children by parental nativity. Compared with US-born children with US-born parents, rates were 32 times higher in foreign-born children and 6 times higher in US-born children with foreign-born parents. (Read the full article)

Previous analyses have documented increased health care costs for children with autism spectrum disorders but have not provided comprehensive estimates of the total economic burden.

There are substantial additional costs associated with caring for children with autism spectrum disorders, amounting to >$17 000 per child annually. Costs accrued outside of the health care system account for the majority of the financial burden. (Read the full article)

Greater numbers of invasive procedures from birth to term-equivalent age, adjusted for clinical confounders, are associated with altered brain microstructure during neonatal care and poorer cognitive outcome at 18 months’ corrected age in children born very preterm.

Altered myelination at school age is associated with greater numbers of invasive procedures during hospitalization in very preterm children without severe brain injury or neurosensory impairment. Greater numbers of invasive procedures and altered brain microstructure interact to predict lower IQ. (Read the full article)