The emergency department (ED) is a critical contact location for youth violence interventions. Information on the characteristics of youth, motivations for fights leading to the injury, as well as previous health service utilization of assault-injured youth seeking care is lacking.

Assault-injured youth are characterized in a systematic sample demonstrating frequent ED use and the need to address substance use and lethal means of force in interventions; context and motivations for the fight are novel and will inform intervention efforts. (Read the full article)

Better postnatal growth, especially head growth, associates with better cognitive development in preterm infants. Suboptimal postnatal growth is more common in infants with poor antenatal growth than in infants with normal growth.

Good weight gain and head circumference growth until 2 years was associated with better 5-year cognitive outcome in non–small for gestational age infants. Good head circumference growth around term age benefits the cognitive outcome of small for gestational age infants. (Read the full article)

The incidence of pertussis has significantly increased, and infection can result in severe disease among young children. This highly contagious disease may frequently be transmitted in pediatric health care settings, necessitating effective infection control practices to reduce exposure risk.

Despite institutional guidelines, pediatric health care workers (HCWs) are frequently exposed to pertussis because of delayed or incomplete adherence to infection control practices. Inconsistent reporting may also result in missed HCW exposures, increasing the risk of subsequent transmission to patients. (Read the full article)

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

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

The management of term and near-term newborns suspected of early-onset sepsis, particularly when they are not clearly symptomatic, remains controversial. Methods for quantifying risk that combine maternal factors with a newborn's evolving clinical examination have been lacking.

This study provides a method for predicting risk of early-onset sepsis. It combines maternal risk factors with objective measures of a newborn's clinical examination and places newborns into 3 risk groups (treat empirically, observe and evaluate, and continued observation). (Read the full article)

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

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

The sensitivities of ^99mTc-dimercaptosuccinic acid in predicting vesicoureteral reflux reported by different institutions were at different levels for young children with acute febrile urinary tract infection.

An acute ^99mTc-dimercaptosuccinic acid scan is of great value in predicting dilating vesicoureteral reflux in children ≤2 years of age with a febrile urinary tract infection. (Read the full article)

Payment arrangements that blend global budgets with pay-for-performance are proliferating. However, little is known about how these contracts affect pediatric health care quality and spending for children with and without special health care needs receiving care from large provider organizations.

A prototypical global budget contract significantly improved preventive care quality measures tied to pay-for-performance, especially for children with special health care needs. It did not alter trends for spending or for quality measures that were not tied to pay-for-performance. (Read the full article)

Preterm infants dependent on parenteral nutrition are vulnerable to deficits in early postnatal nutritional intake. This coincides with a period of suboptimal head growth. Observational studies indicate that poor nutritional intake is associated with suboptimal head growth and neurodevelopmental outcome.

This study provides randomized controlled trial evidence that head growth failure in the first 4 weeks of life can be ameliorated with early nutritional intervention. Early macronutrient intake can be enhanced by optimizing a standardized, concentrated neonatal parenteral nutrition regimen. (Read the full article)

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

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

Preterm infants are at an increased risk of regulatory difficulties during infancy and of behavioral problems in childhood. In the full-term population, persistent crying problems that last beyond 3 months of age have been related to later behavioral problems.

Excessive crying by a preterm infant may reflect an increased risk for later behavioral problems and higher parenting stress even years later. Therefore, it is clinically relevant to assess systematically the crying behavior of preterm infants. (Read the full article)

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

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

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)

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

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

Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals.

In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. (Read the full article)

Kawasaki disease (KD) results in coronary aneurysm formation and an increased risk of cardiovascular complications. Modern treatment of acute KD with intravenous immunoglobulin substantially reduces the rate of acute aneurysm formation.

This study reveals that long-term cardiovascular outcomes for KD patients in the current era are not significantly different than matched controls without KD. Late cardiovascular complications are almost exclusively seen in patients with persistent coronary aneurysms. (Read the full article)

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

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

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

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

Firearm injuries are the second leading cause of death among American children. Previous estimates of nonfatal injuries have relied on small samples of emergency department visits and do not allow a detailed understanding of these injuries among children and adolescents.

In 2009, there were 7391 hospitalizations for firearm-related injuries in US children and adolescents; 89% of hospitalizations occurred in males. Hospitalization rates were highest for 15- to 19-year-olds and for black males. Deaths in the hospital occurred in 6.1% of children and adolescents. (Read the full article)

Sibship size has been negatively associated with children’s language, cognitive, and academic outcomes. This phenomenon is often explained in terms of resource dilution, wherein more children in the home is associated with fewer parental resources allocated to each child.

The current study identifies a moderator of this relationship. Specifically, if children’s next-in-age older siblings exhibit high levels of cognitive sensitivity then sibship size is not significantly related to children’s vocabulary. (Read the full article)

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

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

Asthma morbidity disproportionately affects racial minorities and disadvantaged children. Differences in socioeconomic status and genetics have been offered as explanations but an in-depth understanding of differences in hardships may better explain disparities and also help to identify intervention targets.

Among children admitted for asthma, African Americans were twice as likely to be readmitted as whites. Nearly half the disparity was explained by socioeconomic status and hardships. Community-based interventions targeting hardships may be more feasible given emerging health care payment reform. (Read the full article)

High sodium intake is considered an indirect cause of obesity because it is often accompanied by higher energy intake and sugar-sweetened soft drink consumption. High sodium intake is associated with increased inflammatory response in adult patients.

This study shows that high sodium intake is positively associated with adiposity, leptin, and tumor necrosis factor-α independent of total energy intake and sugar-sweetened soft drink consumption in healthy white and African American adolescents. (Read the full article)

Waning effectiveness of 5 doses of acellular pertussis vaccines is well documented after 6 years of age, but data are lacking for fewer doses in younger children.

In 2- to 3-month-old infants, 1 dose of the diphtheria–tetanus–acellular pertussis vaccine gave significant protection against hospitalized pertussis. The effectiveness of 3 doses decreased from 84% between 6 and 11 months to 59% after 3 years. (Read the full article)

Current guidelines recommend renal ultrasound as a screening test after febrile urinary tract infection, with voiding cystourethrogram (VCUG) only if the ultrasound is abnormal. Few studies have evaluated the accuracy of ultrasound as a screening test for VCUG-identified abnormalities.

This study shows that ultrasound is a poor screening test for genitourinary abnormalities identified on VCUG, such as vesicoureteral reflux. Neither positive nor negative ultrasounds reliably identify or rule out such abnormalities. Ultrasound and VCUG provide different, but complementary, information. (Read the full article)

Although care coordination has been associated with lower health care costs and improved outcomes for vulnerable children, little is known about the extent of need and factors associated with unmet need for care coordination among children with mental health conditions.

Children with mental health conditions have substantial need and unmet need for care coordination. Unmet need is more likely for families with children with anxiety disorder and less likely for those who report social support and family-centered care. (Read the full article)

There is conflicting evidence about the relationship between dental caries in primary teeth and children’s height and weight.

Findings reveal an inverse linear association between caries levels and children’s height and weight. The findings take the argument beyond the presence or absence of an association and provide a better understanding of the pattern of this association. (Read the full article)

Because of high costs of newer vaccines, financial risk to private vaccination providers has increased. Previous studies have shown general dissatisfaction with payment for the cost of vaccines and administration fees, with some providers considering no longer providing childhood vaccines.

We show that many providers are dissatisfied with payment for vaccine purchase and administration from all types of payers and that, for new vaccines, providers are using a variety of strategies with parents to handle uncertainty about insurance coverage. (Read the full article)

Congenital heart disease is known to be a commonly treated and resource-intense condition across children’s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.

Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications. (Read the full article)

The American Academy of Pediatrics (AAP) and other organizations have recommended critical congenital heart disease (CCHD) pulse oximetry screening. Small studies have revealed lower saturations at higher altitude, but this effect on CCHD screening is unknown. The AAP requested additional studies at altitude to help clarify the dilemma.

The AAP has endorsed higher-altitude studies of CCHD screening. This observational prospective study revealed a higher positive screen rate at moderate altitude than at sea level. These findings suggest that current national recommendations may result in increased screening failures at moderate altitude. (Read the full article)

Preterm (PT) birth is negatively associated with growth. Particularly small for gestational age PT infants are at risk for delays in growth, whereas knowledge about the consequences regarding growth of large for gestational age PT birth is lacking.

During infancy, growth in height, weight, and head circumference of large for gestational age PT infants was well balanced and sufficient. Subsequently, however, weight gain accelerated and resulted in high BMIs compared with the World Health Organization Multicentre Growth Reference Study population. (Read the full article)

Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition, typically identified in adolescence and accompanied by physical and social impairment and mood difficulties. There are no long-term studies on the prognosis of adolescents with JFM into adulthood.

This prospective study demonstrated that pain and other symptoms persisted into adulthood for >80% of JFM patients, with associated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adult fibromyalgia. (Read the full article)

Many parenting Web sites encourage use of infant "sleep machines" to play ambient noise while infants sleep. Noise recommendations for hospital nurseries suggest a limit of 50 A-weighted dB, whereas occupational standards limit exposure times for noise >85 A-weighted dB.

We measured the maximum sound level outputs of infant sleep machines and found that several devices are capable of producing levels that may be damaging to infant hearing and may be detrimental to auditory development. (Read the full article)

Little is known about how thirdhand smoke beliefs are related to smoking and quitting behaviors, and how parental smokers’ thirdhand smoke beliefs influence behaviors to protect children. A previous study suggests thirdhand smoke beliefs are associated with home smoking bans.

This is the first study to show that parents’ beliefs about thirdhand smoke are associated with multiple smoking-related attitudes and behaviors that affect the health of children. (Read the full article)

Recent studies have shown that participating in the Supplemental Nutrition Assistance Program (SNAP) is associated with improved household food security. With the exception of 1 descriptive analysis, studies have not examined how SNAP affects children’s food security.

This article estimates the association between SNAP and children’s food security using the largest, most rigorous national study of food security to date. Given current proposals to reduce program size, this study underscores SNAP’s importance in affecting children’s well-being. (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)

Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation.

Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. (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)

We previously reported that parents of children enrolled in genomic research made more restrictive data sharing (DS) decisions than adults. The ethics of pediatric DS have been discussed, but reasons for differences in decision-making have not been explored.

We present an empirically based discussion of attitudes toward and preferences for DS obtained from structured interviews of adult patients and parents of pediatric patients enrolled in genomic research studies. Parents expressed more concern about future risks than adult participants. (Read the full article)

Many children experience the death of a parent during childhood. The long-term consequences of this life event, including school performance, and the importance of the psychosocial circumstances of the home have not been well elucidated in previous studies.

Both maternal and paternal deaths during childhood were associated with lower grades and school failure. Many of the associations (and especially for death due to external causes) were associated with socioeconomic disadvantage and psychosocial problems in the family. (Read the full article)

Diarrhea still remains as a significant cause of morbidity and mortality. Intervention to reduce this risk are needed. Evidence on the effect of Lactobacillus reuteri DSM 17938 to prevent diarrhea in children is scarce.

In healthy children attending day care centers, daily administration of L reuteri DSM 17938 had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infections, with consequent cost saving for the community. (Read the full article)

Adolescents and young adults consume a significant amount of health care resources in our current medical system. With the Patient Protection and Affordable Care Act, a much larger number of previously uninsured young adults (aged ≥19) will be covered.

The Military Health System provides valuable information about the health utilization patterns of adolescents and young adults (aged 12–22) with universal insurance and excellent access to care. This information may help us understand the impact of new health care legislation. (Read the full article)

The period of transition from childhood to adulthood and the period immediately after transfer of care is a challenging time for young people with kidney failure.

Young patients with kidney failure cared for exclusively in adult-oriented facilities experience increased rates of avoidable hospitalizations during late adolescence and young adulthood. Avoidable hospitalizations increased among pediatric kidney failure patients during the years immediately after transfer to adult care. (Read the full article)

Initial studies in children and young adults have identified higher levels of anxiety and lower quality of life scores in patients with implantable cardioverter–defibrillators. Few studies are available looking at the same questions in young patients with pacemakers.

Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation rather than type of device. Patients with pacemakers have depression and anxiety but at lower rates. (Read the full article)

Integrated or collaborative care intervention models have revealed gains in provider care processes and outcomes in adult, child, and adolescent populations with mental health disorders. However optimistic, conclusions are not definitive due to methodologic limitations and a dearth of studies.

This randomized trial provides further evidence for the efficacy of an on-site intervention (Doctor Office Collaborative Care) coordinated by care managers for children's behavior problems. The findings provide support for integrated behavioral health care using novel provider and caregiver outcomes. (Read the full article)

Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prevalence of DKA at diagnosis was 25.5% in 2002–2003.

DKA in youth with type 1 diabetes remains a problem, with almost one-third presenting with DKA. Among youth with type 2 diabetes, DKA was less common and decreased by ~10% per year, suggesting improved detection or earlier diagnosis. (Read the full article)

Resistance exercise is known to have a robust effect on glycemic control and cardiometabolic health among children and adolescents, even in the absence of weight loss.

Normalized strength capacity is associated with lower cardiometabolic risk clustering in boys and girls, even after adjustment for cardiorespiratory fitness, level of physical activity, and BMI. (Read the full article)

Guidelines recommend that primary care physicians provide preventive dental services to young children. Most state Medicaid programs reimburse physicians for providing fluoride varnish. Individual-level studies show that these services are effective in reducing caries-related treatments and costs.

Preventive dental services provided through a North Carolina Medicaid preventive dental program led to a reduction in dental caries among young children statewide. Programs targeting vulnerable populations through medical offices can reduce disparities in oral health among preschool-aged populations. (Read the full article)

Preterm infants have transiently lowered thyroid hormone levels during the early postnatal period. Past research suggests that low thyroid hormone levels are related to cognitive and developmental deficits in children born preterm.

Contrary to expectations, in this study of children born <30 weeks’ gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age. (Read the full article)

Breast tissue may be most sensitive to environmental exposures during adolescence. Carotenoids, a group of pigments found in fruits and vegetables, have antioxidative/antiproliferative properties and may reduce breast cancer risk. Benign breast disease (BBD) is an independent breast cancer risk factor.

In this prospective cohort study, higher adolescent intakes of β-carotene were associated with a lower risk of BBD in young women. BBD prevention may be one of the many positive health effects of fruit and vegetable consumption. (Read the full article)