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)

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)

Chronic fatigue syndrome (CFS) is a disabling illness. Some children with chronic disabling fatigue are housebound. Some primary care physicians find making the diagnosis of CFS difficult.

Chronic disabling fatigue is more common in 13-year-olds than previously realized with a population prevalence of ~2.0%. Chronic disabling fatigue in teenagers is more common in those with higher levels of early family adversity. (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)

Various studies have documented marked racial/ethnic disparities in children’s receipt of dental services at single time points or brief periods.

This study reveals significant improvements in children’s receipt of dental care overall, as well as a dramatic narrowing of African American/white disparities in children’s receipt of dental services over the last 40 years in the United States. (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)

Dental composites composed of bisphenol A (BPA) derivatives are common alternatives to amalgam, but may release BPA. Gestational BPA exposure has been associated with poorer behavior in children. A safety trial of amalgam found worse psychosocial outcomes for children randomized to composites.

In the trial, greater exposure to bisphenol-A-glycidyl-methacrylate-based dental composite in children aged 6 to 10 years was associated with worse self-reported psychosocial functioning at 5-year follow-up. There were no such associations with exposure to dental amalgam or urethane-dimethacrylate-based polyacid-modified composite (compomer). (Read the full article)

Eating disorder not otherwise specified (EDNOS) is the most common eating disorder diagnosis. Binge eating disorder, 1 type of EDNOS, is associated with obesity among adults. Little is known about the health outcomes associated with other types of EDNOS.

This is the first study to evaluate the prospective association of full and subthreshold bulimia nervosa, binge eating disorder, purging disorder, and other EDNOSs with specific mental and physical health outcomes. (Read the full article)

Trisomy 13 and 18 are conditions with 1-year survival rates of less than 10% and have traditionally been treated with palliative care. There are increasing reports of ethical dilemmas caused by parental requests for clinical interventions.

Parents who belong to social networks report an enriching family experience and describe surviving children as happy. Many of these parents describe challenging encounters with health care providers. (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)

Birth defects are associated with preterm birth and are a major contributor to infant mortality. There are persistent black-white differences in overall infant mortality and infant mortality attributable to birth defects.

Among infants delivered at 37 to 44 weeks, blacks and Hispanics had significantly higher neonatal and postneonatal mortality attributable to birth defects than whites. Among infants delivered at 20 to 33 or 34 to 36 weeks, neonatal mortality attributable to birth defects was significantly lower among blacks. (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)

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)

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)

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)

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)

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)

Pediatric specialists are increasingly involved in prenatal care, particularly for congenital fetal conditions. Questions remain about pediatricians’ role in the management of maternal conditions that may affect postnatal health, and the attitudes of obstetric and pediatric specialists around such care.

Obstetric and pediatric specialists’ attitudes differ substantially regarding pediatricians’ role in providing consultation for maternal conditions that may affect a child’s health postnatally, and regarding whether court authorization may be appropriate when a woman refuses certain treatment recommendations. (Read the full article)

Information is limited on adoption of fully functional electronic health records (EHRs) in office-based pediatric practices, such as rates of adoption, barriers to adoption, and features that pediatricians choose.

A nationwide survey of members of the AAP in 2009 found that pediatric adoption of fully functional EHRs lags general adoption. Barriers include financial and productivity concerns, but pediatricians are also concerned about finding systems that meet their specific needs. (Read the full article)

There are a few longitudinal studies that suggest that attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with later psychiatric disorders, substance use disorders, and impaired work performance.

Adolescent ADHD is associated with a variety of internal and external stresses in adulthood. Consequently, it is essential to focus intervention efforts on adolescents with ADHD to prevent or alleviate adult difficulties in functioning. (Read the full article)

Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.

This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims. (Read the full article)

The eating of non–nutrient dense snack foods is considered a major factor contributing to childhood obesity. Parents are often ineffective at encouraging healthier snacking habits.

Children consumed fewer calories when snacking on nutrient-rich cheese and vegetables compared with when they were served potato chips. (Read the full article)

Complementary and alternative medicine (CAM) use is common among children, especially those with chronic, recurrent, or incurable conditions. Concurrent use of CAM with conventional medications is of concern and needs to be assessed, especially in vulnerable patient populations.

CAM use is high among pediatric cardiology, gastroenterology, neurology, oncology, and respiratory patients, most of whom use CAM concurrently with conventional care. This study provides additional evidence to suggest the use of CAM be included in routine patient history taking. (Read the full article)

Few reports have explored the measurement validity of the relative value unit (RVU) system, particularly in pediatrics. The RVU system, although broadly applied in health care settings, was developed for the adult population and thus may possess unique inadequacies in pediatrics.

We found deficiencies in the ability of the RVU system to capture features of case mix complexity and differences related to age. Additional investigation may be warranted to determine the validity of RVU as a measurement tool in pediatrics. (Read the full article)

Evidence regarding effectively screening and counseling adolescents about unhealthy alcohol use is accumulating. Young adults aged 18 to 24, those most at risk for excess alcohol consumption, are often not asked or counseled by physicians about unhealthy alcohol use.

In 2010 among US 10th graders (age 16), 36% drank, 28% binged, and 23% were drunk in the past month; although 82% saw a doctor, 54% were asked about drinking but only 17% were advised to reduce or stop drinking. (Read the full article)

Current measures of risk stratification in the pediatric surgical literature are specialty specific. Although these risk scores have been validated as useful predictors of adverse outcomes, no measures currently exist to assess the full spectrum of pediatric surgery.

Our study generates a multispecialty mortality risk score for pediatric surgical patients that can be used by physicians to identify high-risk patients as well as provide a measure of risk adjustment for surgical outcomes. (Read the full article)

Many studies have identified an association between television viewing and antisocial behavior, although very few have been able to demonstrate a cause-and-effect sequence. The issue of whether excessive television viewing contributes to antisocial behavior remains controversial.

Excessive television viewing during childhood and adolescence was associated with objective and subjective measures of antisocial behavior in adulthood. These associations were not explained by preexisting antisocial tendencies or other potential confounders. Excessive television appears to have long-term psychosocial consequences. (Read the full article)

Failure to thrive (FTT) is a common and vexing pediatric problem. Evaluation has historically involved large batteries of tests, multiple consultations, radiologic studies, and prolonged hospital admissions, resulting in significant costs and inconsistent results.

Scheduled failure to thrive (FTT) admissions on weekends result in increased lengths of stay and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs. (Read the full article)

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. Studies among adults suggest that SNAP participation may be associated with suboptimal diets. Few studies have extensively examined these associations among children.

SNAP participation was not associated with childhood obesity. SNAP children consumed diets poorer in some aspects than nonparticipants, but intake of some micronutrients was higher. The diets of both groups of low-income children were far from meeting dietary guidelines. (Read the full article)

Prenatal alcohol exposure causes a continuum of effects. The most severe phenotype, fetal alcohol syndrome, involves facial dysmorphism, growth deficits, and neurocognitive problems. The classic facial characteristics include short palpebral fissures, smooth philtrum, and thin upper vermillion.

This study develops novel strategies to help detect facial dysmorphism across the fetal alcohol spectrum, especially in children with heavy alcohol exposure but without classic facial characteristics. The methods show potential for identifying which of these children are cognitively affected. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) has been viewed as a neurodevelopmental disorder, adversely affecting behavior and school performance, with studies suggesting increased risk for poor adult outcomes. However, no prospective studies have examined long-term outcomes of childhood ADHD in an epidemiologic sample.

Our epidemiologic study indicates that adults with childhood ADHD are at increased risk for death from suicide. ADHD persists into adulthood in 29.3% of childhood ADHD cases, and 56.9% have ≥1 psychiatric disorder other than ADHD. (Read the full article)

Although amphibians are known Salmonella carriers, aquatic African dwarf frogs are specifically marketed toward children, who are especially vulnerable to Salmonella infections. Both direct animal contact and indirect contact with animal habitats can lead to human Salmonella infections.

This is the first reported outbreak of human Salmonella infections associated with African dwarf frogs, particularly among young children. Parents should be aware of the risk of Salmonella infections from both direct and indirect animal contact. Pediatricians should regularly inquire about animal contact and advise families about risks. (Read the full article)

Expectations are high that electronic health record–based clinical decision support and performance feedback will improve adherence to guidelines by delivering relevant and actionable information to clinicians. Few studies have evaluated these assertions or examined the combined effects of decision support and feedback.

Clinical decision support customized to a patient’s history and presentation and performance feedback are both effective for improving adherence to guidelines for otitis media. However, the combination of the 2 interventions is no better than either delivered alone. (Read the full article)

Children with chronic illnesses are at risk for emotional and behavioral problems. Therefore, interventions that focus on coping with the negative consequences of the disease are needed. Evidence-based interventions are limited and often focus on a single diagnosis group.

This study demonstrates the efficacy of a cognitive-behavioral group intervention for children with various chronic illnesses. The findings indicate that the involvement of parents is important to achieve long-term results. (Read the full article)

Racial disparities in health care have been reported in multiple settings, but not thoroughly examined at the clinician level. The frequent occurrence of respiratory tract infections allows the evaluation of differences in the management of children seen by the same clinician.

Racial differences in the management of common pediatric infections occur among children treated by the same clinician. Given persistent concerns about nonjudicious antibiotic use, examining racial differences may inform our understanding of prescribing practices and identify opportunities for intervention. (Read the full article)

Konzo is an irreversible sudden-onset upper-motor neuron disorder affecting children dependent on bitter cassava for food. The neuroepidemiology of konzo is well characterized. Children subsisting on poorly processed bitter cassava without adequate dietary sulfur-based amino acids are especially at risk.

We found a pervasive subclinical neurocognitive effect in children with konzo. This study provides the first evidence we are aware of that a motor proficiency examination can effectively characterize konzo severity. (Read the full article)

Rates of screen media use have risen in parallel with rates of obesity among young people. Identifying the specific characteristics of media use that are associated with obesity can help elucidate the explanatory processes and inform effective interventions.

This study examines the associations between BMI and characteristics of media use including the type of device, duration of use, and attention to the medium. The more that participants paid primary attention to television, the higher their BMI. (Read the full article)

Forgoing artificial nutrition and hydration in children at the end of life is an acceptable practice under some circumstances. However, there is a paucity of pediatric evidence to guide health care providers’ and parents’ decision-making around this practice.

This study describes experiences of parents whose children died after forgoing artificial nutrition and hydration. All parents were satisfied with their decision and believed their child’s death was peaceful. This study adds to the limited evidence to guide clinical practice. (Read the full article)

Previous studies have suggested that health care providers, family members, friends, and others play a role in shaping parents’ vaccination decisions. Other research has suggested that the media can influence whether parents decide to vaccinate their children.

Through the application of social network analysis, this study formally examines and quantifies how parents are influenced by the people and sources around them. Its findings suggest that social networks are important, particularly for parents who do not completely vaccinate. (Read the full article)

Previous studies have found a relationship between exclusive breastfeeding for ≥6 months and iron deficiency. Little is known about the relationship between total breastfeeding duration, including the period after the introduction of complementary foods, and infant iron status.

Our results suggest that infants with longer total breastfeeding duration may be at risk for iron deficiency. Our findings highlight a clinically important association warranting additional investigation that may inform future guideline updates regarding assessment of risk for iron deficiency in young infants. (Read the full article)

Prompt, high-quality diagnosis of acute pyelonephritis and later identification of children with scarring are important to prevent future complications. Examination by dimercaptosuccinic acid scan is the current clinical gold standard but is not routinely performed.

Procalcitonin demonstrated a more robust predictive ability, compared with C-reactive protein or white blood cell count, to selectively identify both children who had acute pyelonephritis during the early stage of urinary tract infections, as well as those with late scarring. (Read the full article)

The systemic nonselective β-blocker propranolol hydrochloride is increasingly used as first-line management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned.

This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas. (Read the full article)

Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous large-scale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context.

We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. (Read the full article)

Despite evidence on how malpractice risk varies according to physician specialty, there is growing but still limited evidence about malpractice among US pediatricians. The frequency of malpractice claims against pediatricians is low among specialties, but payments are among the highest.

This study describes malpractice risk among US pediatricians using data from a nationwide liability insurer covering 1630 pediatricians from 1991 to 2005. It compares pediatric malpractice experience with other specialties and studies patient factors associated with pediatric malpractice claims. (Read the full article)

The importance of transition from pediatric to adult health care for youth with special health care needs has gained increasing attention over the past decade, but fewer than half of this population received needed transition preparation in 2005–2006.

This study reports on transition findings from the 2009–2010 National Survey of Children with Special Health Care Needs and finds no discernible improvements since 2005–2006. New clinical recommendations and care processes should help to accelerate transition improvements in the future. (Read the full article)

Physicians have little knowledge of health care costs and charges. Studies suggest that education and awareness of hospital finances can decrease unnecessary utilization of resources. Little is known about pediatricians’ awareness of the economics of health care delivery in the inpatient setting.

Both general pediatric attending physicians and trainees acknowledged a limited understanding of hospital finances, and they demonstrated a lack of awareness of costs, charges, and reimbursements for inpatient care. (Read the full article)

Atherosclerotic cardiovascular diseases are rooted in childhood. Vascular intima-media thickness (IMT) and elasticity are early surrogate markers of atherosclerosis. In adults, cardiorespiratory fitness is associated with enhanced arterial elasticity and decreased IMT.

Fitness was favorably associated with aortic IMT and elasticity in adolescents. The association was independent of several cardiometabolic risk factors. In fit adolescents, the increase in IMT during the preceding 6 years was smaller compared with low-fit peers. (Read the full article)

The ideal management of children with vesicoureteral reflux (VUR) remains a source of debate. There is little evidence to support many of the current management practices for children with VUR who have had 1 or 2 urinary tract infections.

Baseline associations, including bladder and bowel dysfunction and imaging studies, from the largest randomized, controlled trial conducted to date aimed at assessing the value of antimicrobial prophylaxis in children with urinary tract infection and VUR are presented. (Read the full article)

Popular press and research show that sibling aggression is common. Too often, however, it is dismissed as benign, and other forms of child aggression, such as peer aggression, are considered more serious. Peer aggression is linked to poorer mental health.

Using a national probability sample, we show that the nature and severity of sibling aggression have negative links to children’s and adolescents’ mental health. We demonstrate that sibling and peer aggression are comparable their links to symptoms of distress. (Read the full article)

Racial and ethnic differences exist in age at diagnosis and early access to mental and behavioral health services among children with autism spectrum disorders (ASDs). ASDs are also associated with increased rates of other medical comorbidities that may require specialty care.

Significant racial and ethnic differences in use of specialty care and specialty procedures exist among children with documented ASD. (Read the full article)