Healthcare Effectiveness Data and Information Set (HEDIS) measures are widely used to assess the reliability of pediatric immunization delivery. The extent to which these measures provide accurate ("is this child up-to-date on immunizations?") and useful ("is this child due for catch-up immunizations?") information is unclear.

Overall, HEDIS childhood immunization measures are accurate and useful. Users of HEDIS data should be aware, however, that certain immunizations (eg, hepatitis B, pneumococcal conjugate) and children (eg, those with a single overdue immunization) are more prone to HEDIS misclassification. (Read the full article)

Tenfold medication error is a well-recognized risk of pharmacotherapy in pediatric practice but little evidence describes the circumstances of such errors.

This study identified 252 tenfold medication errors, 22 of which resulted in patient harm. We identified opioids and other high-risk medications to be associated with tenfold medication error and frequent, recurrent causes, mechanisms, and error enablers that suggest areas for future improvements. (Read the full article)

Cancer in a child may affect the quality of the parents’ relationship, but few studies have examined a potential effect on parental divorce, and no studies have accounted for the proportion of couples that live outside formal marriages.

In this nationwide registry-based study with up to 20 years of follow-up, we included both married and cohabiting couples, reflecting modern family structures. We found that experiencing cancer in a child is not a risk factor for the parents separating. (Read the full article)

Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. It is well known that effective asthma management depends on patient adherence to treatment. The authors of previous cross-sectional studies have linked CAM use with decreased adherence to conventional asthma treatment regimens.

This longitudinal data set was unique, allowing us to focus on patients who initiated CAM and to follow subsequent asthma medication adherence. We found that CAM use was not associated with adherence, suggesting that patients may practice CAM alongside conventional therapies. (Read the full article)

Preterm, growth-restricted infants are at high risk of necrotizing enterocolitis (NEC). NEC occurs most frequently in infants who have received enteral feeds. It is common practice to delay introduction of enteral feeds in these infants.

Early introduction of enteral feeds results in earlier achievement of full enteral feeding. Early feeding is not associated with a higher risk of NEC. Delayed feeding is associated with a higher risk of cholestasis. (Read the full article)

Clinical decision support systems offer a way to help physicians use evidence-based guidelines for screening. Screening patients for common developmental, psychosocial, and behavioral issues informs the clinical decision-making process and may improve patient outcomes.

The Child Health Improvement through Computer Automation system, a clinical decision support system and an electronic medical record, is able to effectively screen patient families in the waiting room by using a tailored questionnaire. The study reveals positive screening rates for identifiable risks in a very large representative urban population by using Child Health Improvement through Computer Automation’s questionnaire. (Read the full article)

Nonadherence to antiretroviral therapy among children and youth with HIV is a frequent problem that can result in treatment failure and disease progression for this population. Children and adolescents face different barriers to adherence than adults infected with HIV.

Few studies have examined specific barriers to adherence as reported by children with perinatally acquired HIV and their caregivers. This report examines the agreement between child and caregiver perceptions of adherence barriers and the factors associated with these barriers. (Read the full article)

We know that many evidence-based treatments for acute asthma are underused, and adherence with treatment guidelines is poor; however, studies have focused on β₂ agonists and corticosteroids, but little is known about intravenous magnesium, which has substantial evidence of benefit.

Magnesium is used infrequently in Canadian pediatric emergency departments in hospitalized children with acute asthma, with variation across sites. More than half of this population does not receive frequent bronchodilators and timely corticosteroids. (Read the full article)

Valid parental permission requires that the decision be both informed and voluntary. Previous research has focused on the informational components of decision-making (eg, disclosure and understanding), with little empirical attention to the voluntariness of decisions.

We address this gap by examining the voluntariness of parents making research or treatment decisions in pediatric oncology. We identify demographic and contextual correlates of voluntariness and highlight the clinical implications of the findings for physicians and investigators. (Read the full article)

Asthma disparities exist, with Latino children of Caribbean descent at risk for poor disease control. Controller medications reduce symptoms; however, medication adherence remains suboptimal. Identifying what factors predict poor medication adherence in at-risk groups could identify important treatment targets.

This study is the first to assess objective rates of medication use among children with asthma in Puerto Rico. Findings suggest that interventions incorporating family resources and addressing parental beliefs about medications may be of benefit across cultural groups. (Read the full article)

More than one-tenth pediatric patients use complementary and alternative medicines (CAM) for their medial conditions in the United States. Traditional Chinese medicine (TCM) is the most commonly used CAM in East Asia but large-scale epidemiologic studies are lacking.

In comparing TCM and non-TCM users among children in Taiwan, children’s age and parental TCM use were strongly associated with TCM use. Additionally, dyspepsia and allergic rhinitis were positively related to increasing TCM use. (Read the full article)

Batteries, especially button batteries, are an important source of pediatric injury. Recent reports suggest that fatal and severe button battery ingestions are increasing.

An estimated 3289 battery-related ED visits occurred annually among US children <18 years of age, averaging 1 visit approximately every 3 hours. The number and rate of visits increased significantly during the 20-year study period, driven by increases during the last 8 study years. (Read the full article)

Survival of children born with Down syndrome has been improving, but few studies have used population-based data to examine the influence of fetal and maternal characteristics on survival.

This study examined predictors of survival for children born with Down syndrome using population-based data from the UK Northern Congenital Abnormality Survey and shows that year of birth, gestational age, birth weight, and presence of additional anomalies influence survival status. (Read the full article)

There is a paucity of controlled studies of recombinant factor VIIa (rFVIIa) use for off-label indications in pediatric patients. Data on the use of off-label rFVIIa, including safety and efficacy, are mostly limited to case reports or small case series.

This is the largest reported case series of off-label rFVIIa in pediatric patients from a well-designed, representative, and rigorously audited registry of rFVIIa use and describes the indications for use, dose administered, adverse events, and outcomes in 388 patients. (Read the full article)

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

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

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

Although many children are treated in general emergency departments, many such facilities have limited pediatric capabilities. Transfer to academic centers improves outcomes for critically ill patients, but transfers of noncritically ill children have not been well studied.

Although more than half of these patients are seriously ill, many transferred patients are discharged directly from the emergency department or are admitted for less than 24 hours. Orthopedic problems, gastrointestinal conditions, and traumatic head injury are the most common complaints. (Read the full article)

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

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

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a significant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling.

We provide the first nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socioeconomic factors and access to health care affect whether adolescents receive these services. (Read the full article)

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

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

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)

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)