Follow-up skeletal surveys are conducted commonly in children with suspected physical abuse, despite limited evidence. Different guidelines recommend follow-up skeletal surveys in children with abnormal initial skeletal surveys or in cases with high risk.

Across several centers, follow-up skeletal surveys revealed new information in >20% of cases and frequently affected the perceived likelihood of abuse, even in cases where the initial level of concern for abuse was moderate. (Read the full article)

Reductions in infant mortality in the 20th century have not continued. Racial and socioeconomic inequalities in both infant mortality and sudden infant death syndrome (SIDS) persist. Rates of infant mortality in English-speaking countries are higher than the Organisation for Economic Co-operation and Development average.

At least 16.4% of SIDS and 3.4% of infant deaths not classified as SIDS are attributable to maternal alcohol use. Maternal alcohol-use disorder increases the risk of infant mortality through direct effects on the fetus and indirectly through environmental risk factors. (Read the full article)

While obesity-promoting eating, sedentary and physical activity behaviors, and increased prevalence of adiposity are evident from early life, few high-quality studies have evaluated interventions that seek to influence the development of these behaviors in very early childhood.

This study highlights the receptivity of first-time parents to interventions focused on their new infant’s eating and active play and provides evidence of effectiveness on some obesity-promoting behaviors in very early childhood. (Read the full article)

Although it is known that relatively minor abusive injuries sometimes precede more severe physical abuse, the prevalence of these previous injuries in infants evaluated for abuse was not known.

A history of bruising or oral injury in a precruising infant evaluated for abuse should heighten the level of suspicion because these injuries are common in abused infants and rare in infants found not to be abused. (Read the full article)

Diuretics are used in preterm infants to treat the symptoms of bronchopulmonary dysplasia (BPD), although there is little evidence of their effectiveness in improving long-term outcomes. Prescribing patterns and frequency of diuretic use in patients with BPD are unknown.

The use of diuretics in infants with BPD, including the specific medications used and length of treatment, varies widely by institution. Long-term diuretic administration to patients with BPD is commonly practiced despite minimal evidence regarding effectiveness and safety. (Read the full article)

College students with asthma tend to have worse health outcomes than their peers without asthma. Consistent use of controller medication could improve outcomes for these students, but a predictive model of appropriate use of controller medication is needed.

This study adds risk tolerance and time preference to previously studied factors of nonadherence with control medication. These preferences have substantial impacts on use of controller medication and the potential success of asthma education programs. (Read the full article)

Despite downward trends, the US teen birth rate remains among the highest of developed nations. Childhood maltreatment may place teens at higher risk, but inferences are weak given a lack of prospective study and control for alternative explanations.

Results from the first controlled, prospective study of nulliparous teenagers confirm that victims of maltreatment are more than twice as likely as their nonmaltreated peers to experience a teen childbirth after controlling for demographic confounds and other known risk factors. (Read the full article)

Early detection for children with autism leads to better outcomes; early screening is critical. The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used instrument for early autism screening and is recommended by the American Academy of Pediatrics.

This large study provides empirical support for population screening for autism spectrum disorders and the use of the M-CHAT in primary care settings. This study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers. (Read the full article)

Among adolescents younger than 15, 18% have had sex and 16 000 pregnancies occur annually; among those aged 15 to 17, 30% have had sex and 252 000 get pregnant. Information on the youngest adolescents has not been previously published.

Sexual activity and pregnancy are rare among 10-, 11-, and 12-year-olds, and sex is more likely to be nonconsensual. This arguably represents a different public health issue than sex among older teens, who have a greater need for contraception. (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)

Botulinum spores are ubiquitous, found in the soil of most countries worldwide, and also in honey. It is well established that ingestion of honey by children aged <1 year can lead to infant botulism.

This study examines the prevalence of honey pacifier use among a pediatric population aged <1 year. We also assessed parental knowledge of the dangers of giving honey to children in this age group. (Read the full article)

Extremely preterm infants who receive antihypotensive therapy have worse outcomes than untreated infants. The reasons for this are not clear. High-quality randomized trials have not been performed to date because of logistical challenges, thereby necessitating alternative methods of investigation.

Antihypotensive therapy administration was not associated with improved in-hospital outcomes for any of the 15 definitions of low blood pressure investigated. Alternative methods of deciding who to treat are needed to maximize patient benefit and minimize harm. (Read the full article)

The American Academy of Pediatrics recommends that all preterm infants receive human milk; however, little is known about the use of human milk in US advanced care neonatal units.

Routine use of human milk and use of donor milk in neonatal advanced care units increased from 2007 to 2011, particularly among units providing intensive care. There is geographic variation in the use of human milk in these units. (Read the full article)

Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.

This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings. (Read the full article)

Child welfare data show declines in child physical abuse since the early 1990s, but analysis of national data from hospitalized children in the Kids’ Inpatient Database showed an increased incidence of serious physical abuse in children from 1997 to 2009.

We found no significant change in hospitalization rates for injury from abuse in young children and increases in injury severity using the National Inpatient Sample from 1997 to 2009. This data helps provide a more complete perspective of the problem. (Read the full article)

Routine head ultrasound scans (HUSs) are frequently performed in the preoperative evaluation of the infants with congenital heart disease, and brain MRI is being increasingly used in the research setting. The utility of HUSs in this population has not yet been established.

This is the first study to prospectively evaluate the utility of routine HUSs compared with MRIs in asymptomatic newborns and young infants undergoing cardiac surgery. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD. (Read the full article)

Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications.

Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, β-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. (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)

Obstacles to vaccine delivery, including poverty, reduced access to medical care, and incomplete understanding of vaccine safety and importance, result in suboptimal coverage rates in some populations, allowing for disease outbreaks. Multicomponent interventions are successful in increasing immunization coverage rates.

We show that collaboration with local resources, including the county health department and a large community-based organization, effectively increases immunization coverage rates in low-income, resource-poor children. (Read the full article)

Language barriers adversely affect health care access, utilization, outcomes, and patient safety. Trained formal interpreters can improve care quality and safety, but many patients and families with limited English proficiency do not receive appropriate language services during health care encounters.

Despite continued growth of the US population with limited English proficiency, federal language use standards, and enhanced education about appropriate use of language services, there has been only modest improvement over time in pediatricians’ use of language services. (Read the full article)

Patients with hereditary angioedema (HAE) have recurrent episodes of painful swelling. Several new therapies to prevent and treat HAE attacks are approved by the Food and Drug Administration, but their safety and efficacy in children are largely unknown.

Ecallantide appears effective for treatment of HAE attacks in pediatric patients age 10 to 17 years with an acceptable safety profile. It represents a potential treatment option for adolescents with HAE. (Read the full article)

Diabetic ketoacidosis (DKA) is a short-term complication of type 1 diabetes and is a major cause of preventable hospitalization in children. Hospital resource utilization and readmission rates for DKA across the US are not known.

Readmission for DKA within a year of hospitalization is common, accounting for one-fifth of all DKA admissions. Resource use, hospital length of stay, and readmission rates vary widely across major US children’s hospitals, even after adjusting for hospital differences in patients. (Read the full article)

Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.

Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. (Read the full article)

Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied.

Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. (Read the full article)

Despite declines in cigarette smoking, smokeless tobacco use among youth has remained unchanged in the United States. Modified or novel smokeless tobacco products are being increasingly promoted to youth in the United States as an alternative to smoking.

Among US students in grades 6 through 12, 5.0% used snuff or chewing or dipping tobacco, whereas 2.2% used snus or dissolvable tobacco products. Approximately two-thirds of smokeless tobacco users concurrently smoked combustible tobacco; risk perception of all tobacco products was protective of smokeless tobacco use. (Read the full article)

Adolescents are likely to smoke if their parent(s) smoke. Little research uses prospective longitudinal data from parents and children to more confidently document these intergenerational associations, alongside potential confounders (parental education) and mediators (school achievement, mental health, older sibling smoking).

Analyses of long-term multigenerational data show how diverse parental smoking trajectories influence child smoking, controlling for measured confounders. The risk of smoking is especially high among children residing with a persistent heavy smoking parent and an older sibling who smokes. (Read the full article)

The diagnosis of urinary tract infection (UTI) is confirmed by urine testing with urinalysis and culture. No study has characterized the use of urine testing in the setting of empirical antibiotic prescription for outpatient UTI in children.

Urine tests are not performed in a substantial percentage of antibiotic-treated pediatric UTIs. Additional research is necessary to determine whether empirical antibiotic prescription for UTI in children without urine testing is safe and effective. (Read the full article)

Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deficit/hyperactivity disorder (ADHD), ample evidence demonstrates that they continue to diagnose and treat this disorder suboptimally.

The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. (Read the full article)

Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use.

In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children, and those lacking private health insurance was documented. (Read the full article)

In January 2006, a public health advisory and boxed warning for long-term safety and the risk of malignancies and a medication guide were issued for topical calcineurin inhibitors, tacrolimus and pimecrolimus.

Evaluation of off-label use of topical calcineurin inhibitors in children before and after regulatory action by the Food and Drug Administration is important to understand the impact of regulatory action. (Read the full article)

Use of complementary and alternative medicine (CAM) is increasingly common among American youth; however, information on use of CAM among youth with recurrent headache (HA) is limited.

Youth across a range of chronic conditions experience HA. These youth are more likely to use CAM. Use and expenditures for conventional medical care, and increased difficulties in activity and functioning are greater for youth with HA who use CAM. (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)

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)

Socioeconomic status is known to influence health and health care utilization, but few studies have explored the relationship between community-level income and inpatient resource utilization for children.

In a large sample of pediatric hospitalizations, lower community-level household income is associated with higher inpatient costs of care for common conditions. These findings highlight the need to consider socioeconomic status in health care system design and reimbursement. (Read the full article)

Use of behavioral health (BH) screens in pediatrics have increased identification of children with BH issues. Screening rates increased in Massachusetts after it was mandated, as did the volume of some mental health services.

This is the first study of children after Massachusetts mandated behavioral screening began. Almost 40% of children who screened positive were newly identified. Being male, having a BH history, and being in foster care predicted a positive screen. (Read the full article)

Increasing numbers of hospitals are instituting 24/7 in-hospital pediatric intensivist coverage. Data regarding patient outcomes are mixed and the impact on housestaff education remains unknown.

This study quantifies the perceived impact of in-hospital attending coverage on pediatric resident and critical care fellow education and also investigates the growing concern that increasing supervision may contribute to housestaff being less well prepared for independent clinical practice. (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)

Age-appropriate child safety seat use in the United States is suboptimal, particularly among children older than 1 year. Minority children have higher rates of inappropriate child safety seat use based on observational studies. Explanations for observed differences include socioeconomic factors.

White parents reported greater use of age-appropriate child safety seats for 1- to 7-year-old children than nonwhite parents. Race remained a significant predictor of age-appropriate restraint use after adjusting for parental education, family income, and information sources. (Read the full article)

Celiac disease (CD) often goes undiagnosed. Current guidelines suggest intensified active case-finding, with liberal testing of children with CD-associated symptoms and/or conditions. However, methods for also finding undiagnosed CD cases in the general population should be explored and evaluated.

In a population-based CD screening, information on CD-associated symptoms and conditions, obtained before knowledge of CD status, was not useful in discriminating undiagnosed CD cases from non-CD children. The majority of screening-detected CD cases had no CD-associated symptoms or conditions. (Read the full article)

Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents.

Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible. (Read the full article)

Quantitative real-time polymerase chain reaction allows sensitive detection of respiratory viruses. The clinical significance of detection of specific viruses is not fully understood, however, and several viruses have been detected in the respiratory tract of asymptomatic children.

Our results indicate that quantitative real-time polymerase chain reaction is limited at distinguishing acute infection from detection in asymptomatic children for rhinovirus, bocavirus, adenovirus, enterovirus, and coronavirus. (Read the full article)

Concussions in youth are a common injury evaluated in the emergency department (ED). Early recognition and active management of this mild traumatic brain injury are important to safe recovery. Tools to assess and manage concussion in the ED are lacking.

Acute Concussion Evaluation tools, modified for ED use, improved reported follow-up with primary care or concussion specialists and adherence to recommendations. Barriers to follow-up remain and the importance of ongoing outpatient management should be stressed. (Read the full article)

Mobile devices are ubiquitous in children’s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiver–child interactions, has not been studied.

In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction. (Read the full article)

Childhood attention-deficit/hyperactivity disorder has been associated with both childhood and adult obesity, whereas treatment with stimulants has been associated with delayed child growth. No longitudinal studies with details about dates of diagnosis, treatment, and duration of stimulant use have been published.

Using electronic health record data, this was the first study to evaluate the independent associations of attention-deficit/hyperactivity disorder diagnosis, stimulant treatment, age at first stimulant use, and duration of stimulant use on longitudinal BMI trajectories throughout childhood and adolescence. (Read the full article)

Individuals with DiGeorge syndrome (DGS) have varying degrees of immunodeficiency. All are susceptible to vaccine-preventable infections with serious complications. Although live vaccines are generally contraindicated in this population, limited evidence suggests that they may be effective and safe for select individuals.

Many individuals with DGS received live vaccines despite having a known diagnosis. Adverse events following live immunizations were typically minor and self-limited, suggesting that live vaccines may be considered for patients with DGS who exhibit mild-to-moderate immunosuppression. (Read the full article)

Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like selective serotonin reuptake inhibitors (SSRIs). Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear.

This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays. However, underlying depression and its genetic underpinnings may be a confounder. (Read the full article)

The widely disseminated National Institute on Alcohol Abuse and Alcoholism screening tool for adolescent alcohol use was developed based on epidemiologic data. It has not been validated in a clinical sample and does not screen for tobacco or drug use.

This study found that a measure that expanded the National Institute on Alcohol Abuse and Alcoholism adolescent alcohol use tool to include tobacco and drugs was sensitive and specific for identifying substance use disorders in a pediatric clinic patient population. (Read the full article)

A large majority of preschool and young school age children with mental health problems do not receive services and little is known about the determinants of service use in this age group.

Behavioral, not emotional, disorders increase service use but only if impairment is present. Such impairment may operate via increased parental burden and parent and caregiver problem recognition. Low socioeconomic status has an independent effect increasing service use. (Read the full article)

Homicide is the third leading cause of mortality in general population youth aged 15 to 29 years. Groups at greatest risk for early violent death (racial/ethnic minorities, males, poor persons, and urban youth) are overrepresented in the juvenile justice system.

We examined rates of and risk factors for firearm homicide and other causes of death in delinquents 16 years after detention. Our study analyzes gender differences; compares Hispanics, African Americans, and non-Hispanic whites; and includes a representative sample of delinquents. (Read the full article)