Because pediatric appendicitis is challenging to diagnose, computed tomography (CT) is used frequently. Childhood radiation exposure is associated with increased risk of cancer. Ultrasound avoids radiation exposure but is less sensitive for appendicitis than CT.

Controlling for referral bias, evaluation at a community compared with a children’s hospital is associated with higher CT and lower ultrasound use before appendectomy. CT and ultrasound accuracy for appendicitis in children varies with hospital type. (Read the full article)

Part C early intervention serves ~2.8% of US children who are younger than 3 years old; however, there is evidence that substantial numbers of infants and toddlers with developmental delays receive no early intervention services.

Broad eligibility criteria can classify children who have no delays or minimal delays as candidates for Part C services. Despite this, no jurisdiction provides Part C services to all children who have substantial delays. (Read the full article)

Adequate vitamin D is essential for skeletal health in developing children. Although excess body weight is associated with risk of vitamin D deficiency, the national prevalence of vitamin D deficiency in overweight and obese children is unknown.

Vitamin D deficiency is highly prevalent in overweight and obese children, and severely obese and minority children are disproportionately affected. There are many modifiable factors associated with vitamin D deficiency in overweight and obese children. (Read the full article)

Lifestyle and vulnerability associated with food allergy might predispose affected children to being bullied. Our previous parent survey identified high rates of bullying in this population, but child reports and emotional impact were not assessed.

Bullying was common, often involving threats with food. Bullied food-allergic children, compared with nonbullied, report higher anxiety and lower quality of life. Parental awareness of bullying (~50% of cases) was associated with better social and emotional functioning in the child. (Read the full article)

Childhood headache is a common medical condition and can negatively impact a child’s social and academic life in several ways. Early and accurate diagnoses of headache syndromes, including migraine, are essential to appropriate treatment and outcome for affected youth.

The Diagnostic Interview of Headache Syndromes–Child Version is a new tool for the assessment of pediatric migraine that can enhance the standardization of collection of diagnostic criteria in both clinical and community settings, leading to better recognition and treatment of this condition. (Read the full article)

Influenza is an important cause of medically attended illness in young children before expanding influenza vaccine recommendations for children.

This study characterizes the health care burden of influenza in young children over 5 years (2004–2009) when influenza vaccine recommendations were expanded to all children aged ≥6 months. (Read the full article)

Paternal mental disorders during the postnatal period are associated with an increased risk for behavioral and emotional problems in their children; however, less is known about the effect of fathers’ mental health during pregnancy on children’s development.

The study demonstrated a positive association between fathers’ prenatal mental health and their children’s subsequent socioemotional and behavioral development. Psychological distress in fathers was associated with a risk for emotional difficulties in their children at 36 months of age. (Read the full article)

Validated questionnaires can improve the identification of psychosocial problems among children. The Strengths and Difficulties Questionnaire (SDQ) 3-4 is a promising option. However, no studies are available that examine the psychometric properties of the SDQ parent form 3-4.

The results of this study show that the SDQ 3-4 is a valid tool for the identification of psychosocial problems in preschool-aged children. (Read the full article)

Children with sickle cell anemia are at risk of central nervous system damage, including stroke. Even children without evidence of abnormality on neuroimaging are at risk of significant declines in neurocognitive function, starting at early ages.

This study adds the observation that poorer neurocognitive and behavioral function is associated with older age in infants and toddlers with sickle cell anemia, much earlier than previously expected. (Read the full article)

First drink before age 15 greatly increases the likelihood for later alcohol abuse or dependence. Separate investigations have linked many variables to alcohol initiation, but few have attempted to identify the optimal combination of predictors for age of alcohol initiation.

This article supports the screening questions selected in the joint National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics initiative to identify and initiate intervention in youth at risk for early use of alcohol. (Read the full article)

Educational debt is an important topic in pediatrics. Deciding on a career path is a critical personal decision, shaped by multiple factors. The relationship between educational debt and career choice is unclear.

Educational debt among graduating pediatric residents is high and continues to increase. Higher debt is one factor that may lead residents toward a career in primary care or hospitalist practice, rather than pursuing fellowship training and a subspecialist career. (Read the full article)

Previous studies suggest that hospitals under the greatest financial strain may be more prone to adverse events because they have limited resources to invest in quality and safety.

The patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories. (Read the full article)

A number of studies have demonstrated community acceptance of Safe Routes to School interventions as well as their success in addressing perceptions about safety, but little is known about their effectiveness in reducing pedestrian injury risk in school-aged children.

Implementation of a Safe Routes to School program in New York City may have contributed to a substantial reduction in school-aged pedestrian injury rates, with the effects largely limited to school-travel hours in census tracts with these interventions. (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)

A reduced nephron number is associated with glomerular hyperfiltration, resulting in renal injury such as hypertension, proteinuria, and chronic kidney disease. Patients with a solitary functioning kidney have an increased risk of dialysis in early adulthood.

This study demonstrates that a subset of children with a solitary functioning kidney progress toward renal injury during childhood. Risk factors for renal injury are ipsilateral anomalies of the kidney and urinary tract and small renal length. (Read the full article)

Effective interventions are still elusive for the large numbers of children affected by overweight/obesity. The value of targeting physical activity (PA) remains unclear because its predictive relationship with improved BMI is still surprisingly poorly quantified.

In overweight and mildly obese children presenting to primary care, 3-year changes in PA (especially the moderate-vigorous component) predicted BMI outcomes. However, the effect was small, possibly explaining the disappointing BMI outcomes of brief primary care interventions targeting PA. (Read the full article)

Presleep activities (eg, television watching) have been implicated in the declining sleep duration of young people. However, previous research reported on selected presleep activities, raising the possibility that important activities in this period are not accounted for.

This is the first study in youth to construct the presleep period by using a use-of-time approach. Twin trajectories of higher screen time and lower nonscreen sedentary time/self-care were evident in late sleepers, with the opposite pattern occurring in early sleepers. (Read the full article)

Heuristics are decision-making aids or shortcuts that ease the task of making a wide variety of decisions in diverse contexts. Little is known about the heuristics that parents of children with serious illness use when confronting difficult decisions.

Parents of children with life-threatening illnesses use several different types of heuristics, explicitly, in making sense of complex situations, making decisions, and communicating these decisions to others. Better understanding of these heuristics may improve communication and decision support. (Read the full article)

Previous evaluations of local reactions after the fifth diphtheria-tetanus-acellular pertussis (DTaP) vaccine in children 4 to 6 years of age have revealed that vaccination in the thigh is associated with a lower risk of local reactions compared with vaccination in the arm.

Among children 12 to 35 months of age, injection of DTaP vaccine in the thigh is associated with a lower risk of local reactions compared with vaccination in the arm. (Read the full article)

Routine screening of potentially abused children with hepatic transaminases has been recommended, using a threshold of 80 IU/L to determine the need for further testing, but practice is variable, and this threshold has not been validated.

This study identified abdominal injury in a significant fraction of potentially abused children with transaminases >80 IU/L. (Read the full article)

Care coordination has been proposed as a key mechanism for increasing quality and reducing costs of care. Little is known about the degree to which disparities exist in care coordination or whether having high-quality primary care attenuates disparities.

A considerable proportion of parents reported unmet care coordination needs for their children, especially parents of children with special health care needs. Black and Latino children also may have more unmet needs because they received family-centered care less often. (Read the full article)

A small number of studies have found that the introduction of smoke-free legislation has been associated with a reduction in hospital admissions and emergency department visits for asthma.

The implementation of smoke-free legislation in England was associated with an immediate 8.9% reduction in hospitalizations for asthma along with a decrease of 3.4% per year. (Read the full article)

The American Academy of Pediatrics recommends that infants <1500 g birth weight receive an iron intake of 4 mg/kg per day. There are no randomized trials to support this recommendation.

This trial compared the effect of iron supplementation of 2 mg/kg per day on the hematocrit at 36 weeks' postmenstrual age. This study concluded that iron supplementation does not affect the 36-week hematocrit or the number of transfusions in infants <1500 g. (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)

Prevalence of hypertension in children increased significantly over the past few decades, tracks into adulthood, and is a major risk factor for cardiovascular disease. However, current prevalence estimates in children have largely been based on studies conducted in school environments.

The current study reports the prevalence of childhood hypertension in community pediatric practice, which provides a typical pediatric examination environment, unlike blood pressure measured in school. The results show a significantly lower prevalence than what has previously been reported. (Read the full article)

In inverse proportion to the steadily declining under-5 mortality rate, prevalence of childhood disability has doubled in the past decade in Bangladesh. The Rapid Neurodevelopmental Assessment (RNDA) tool has been shown to be reliable and valid for assessment of a range of neurodevelopmental impairments (NDIs) and disabilities in children younger than 2 years. There is currently a lack of professional expertise for assessing NDIs in 2- to 5-year-old children in low- and middle-income countries.

We developed a set of instruments as part of the RNDA for administration by a single professional with experience in child development to assess >2- to 5-year-old children for a wide range of NDIs. The tool was acceptable to mothers, interrater reliability was high, and proportions of children with NDIs were elevated among the lowest income groups and in stunted children, demonstrating discriminant validity. The RNDA was valid for identifying >2- to 5-year-old children with a range of NDIs, especially in cognitive, behavior, and motor functions. Validity of the RNDA for vision, hearing, and seizure disorders needs further research. (Read the full article)

Peer victimization predicts numerous health risks. Lesbian, gay, and bisexual (LGB)-identified youth report greater peer victimization than do heterosexual-identified youth. No longitudinal studies have been conducted on developmental trends of peer victimization and emotional distress among LGB and heterosexual youth.

We provide the first longitudinal evidence on developmental trends of peer victimization and emotional distress for LGB- and heterosexual-identified youth. The findings suggest peer victimization of LGB-identified youth decreases in absolute, but not necessarily relative, terms and contributes to later emotional distress disparities. (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)

Amblyopia affects 2% to 4% of the US population and is preventable In January 2011, the US Preventive Services Task Force concluded there is insufficient evidence to support vision screening in children younger than age 3 years.

Results of the Iowa photoscreening program in 210 695 children older than 11 years suggest photoscreening reliably detects amblyogenic risk factors in children 1 to 3 years of age, and we recommend photoscreening children starting at 1 year of age. (Read the full article)

Among youth with asthma, tobacco smoke exposure causes increased asthma morbidity. Little is known about changes over time in tobacco smoke exposure among youth with asthma in a national sample.

Our analysis reveals a decrease in environmental tobacco smoke exposure among children and adolescents with current asthma in the United States from 1988–1994 to 2005–2010, but a majority of youth with asthma remain exposed to environmental tobacco smoke. (Read the full article)

Research indicates that adolescents who perceive their school to have a positive socioeducational environment are at reduced risk of developing depressive symptoms. However, there is limited evidence that school environments can influence adolescent emotional health independently from individual perceptions.

This multilevel longitudinal study shows that better school socioeducational environments, as assessed at the school level, reduce the prospective risk of depressive symptoms in adolescents. This association is shown to be independent from confounders and stronger in girls than boys. (Read the full article)

Urban children suffer disproportionately from asthma, and suboptimal treatment with preventive medications is common. Although several programs have been developed to reduce morbidity for urban children with asthma, their economic feasibility and sustainability remain unknown.

Our study demonstrates that the school-based asthma therapy program could be an economically effective program for children aged 3 to 10 years attending preschool or elementary school in a city school district, at the cost of $10/symptom-free day. (Read the full article)

The rise in type 2 diabetes in youth is a major public health concern thought to be partially due to decreasing activity levels and increasing obesity. The role of sedentary time as a possible contributor also needs to be examined.

Measured objectively, obese youth, with or without type 2 diabetes, spend little time in moderate to vigorous physical activity. Those with type 2 diabetes, however, were significantly more sedentary than their obese counterparts, identifying an important area for future intervention efforts. (Read the full article)

In humans, the brain growth spurt begins in the last trimester of pregnancy and extends through the first 2 years of life. Studies show poor cognitive and motor development among children who have iron deficiency anemia in infancy.

Prenatal iron deficiency anemia in the third trimester affects child mental development. Prenatal micronutrient supplementation with sufficient iron protects child mental development even when the woman’s iron deficiency anemia is not properly corrected during pregnancy. (Read the full article)

Bisphenol A (BPA) is an environmental endocrine disruptor that can leach from polycarbonate plastics and epoxy resins, leading to widespread exposure. Fetal and early postnatal periods are particularly vulnerable to exposure to BPA.

This study identified medical devices as a potential source of exposure to BPA among premature infants in the NICU, even when efforts to reduce polycarbonate plastics were taken. (Read the full article)

Impaired visual development has been reported in infants born to mothers prescribed methadone in pregnancy. Immature visual evoked potentials have been reported in this population, but data were confounded by gestation, growth restriction, and illicit drug use.

Visual evoked potentials are small and immature in infants exposed to methadone and other drugs of misuse in utero. These changes are independently associated with methadone exposure and persist after controlling for gestation, socioeconomic deprivation, alcohol consumption, and cigarette smoking. (Read the full article)

Most studies focus on health of foster children or local samples of young children. One previous study examined a national cohort longitudinally but did not address the full age group or range of conditions at the time of initial investigation.

Using 2 approaches to assess children (aged 0–17.5 years) who have chronic health conditions, we found that regardless of placement, investigated children had much higher rates of these conditions than the general population at the time of initial assessment. (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)

The presence of elevated cardiometabolic risk factors, such as obesity, high glucose or lipid levels, and smoking, in adolescents has been shown to be associated with earlier onset of chronic conditions, such as diabetes and heart disease.

Obesity, smoking, and elevated glucose increases the risk of dying before the age of 55 years. This is the first study to focus on risk factors and mortality among adolescents and young adults in a nationally representative US sample. (Read the full article)

Children have been shown to imitate behaviors they see on screen.

Modifying what children watch can improve their observed behavior. (Read the full article)

Isolated case reports of abnormal voice after extremely preterm birth are well described; however, there are no systematic studies of long-term voice outcomes in children born preterm.

Significant voice abnormalities were found in more than half of tested children born before 25 weeks’ gestation. Multivariable analyses showed that the number of intubations, not the duration of intubation, and female gender were strongly associated with this adverse outcome. (Read the full article)

Children with Lyme and septic arthritis of the knee may present similarly, although septic arthritis requires prompt treatment initiation to avoid joint destruction. Clinicians must make initial management decisions without Lyme serology and bacterial culture results.

Our clinical prediction rule accurately identified patients at low risk for septic arthritis in a Lyme disease–endemic area. In the appropriate clinical context, low-risk patients may be spared invasive testing such as diagnostic arthrocentesis. (Read the full article)

Celiac disease is increasing in several countries and has emerged as a public health problem. Infant feeding has been suggested to affect celiac disease development and/or clinical expression. However, evidence-based complementary feeding strategies are limited.

Significant difference in celiac disease prevalence between 2 cohorts of 12-year-olds indicates an option for disease prevention. The cohorts differed in infant feeding, and our findings suggest that gradual introduction of gluten in small amounts during ongoing breastfeeding is favorable. (Read the full article)

There is a lack of consensus regarding the optimal investigative approach after a first febrile urinary tract infection. This is because of uncertainty regarding the long-term clinical significance of vesicoureteral reflux and urinary tract infection–related renal scarring.

No ideal diagnostic algorithm exists. We found marked variability in sensitivity and specificity for detection of abnormalities using current protocols. We also highlight the considerable cost differences, both financially and in terms of radiation dose, of different protocols. (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)

Of more than 2 million children infected with HIV, almost 90% live in resource-limited settings where pediatric HIV care is often suboptimal. Implementing electronic health records with computerized decision support offers a potential tool for improving care.

This randomized, controlled trial demonstrates that computer-generated clinical reminders can significantly improve clinician compliance with HIV care guidelines for children in a resource-limited setting. This intervention is scalable as developing countries implement electronic health record systems. (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)

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)

Skin and soft tissue infections (SSTIs) are a common pediatric condition often requiring inpatient management. Several studies describe recent increases in hospitalizations due to SSTIs.

In addition to rising hospitalizations, analysis of pediatric SSTI resource utilization trends revealed a twofold increase in incisions and drainages over a 13-year period. A growing number of incisions and drainages were performed in younger children. (Read the full article)

Children with acute liver failure due to a single-dose acetaminophen exposure have a characteristic liver biochemistry profile of low conjugated bilirubin and high alanine aminotransferase, which is associated with a favorable clinical outcome when treated with N-acetylcysteine.

Children with acute liver failure associated with chronic acetaminophen exposure also have a similar liver biochemistry profile, but for unknown reasons, they have a poorer clinical outcome than patients with single-dose acetaminophen exposure. (Read the full article)