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)

Neonatal hearing screening occasionally fails because of several perinatal and neonatal factors. However, the effect of mode of delivery on hearing screening has not yet been established.

We show significantly more failures on hearing screening in cesarean delivery infants. Hence, the timing of screening after cesarean delivery should preferably be postponed beyond 48 hours to improve success rate, minimize maternal anxiety, and decrease costs. (Read the full article)

Parents are increasingly following alternative immunization schedules. Current studies suggest up to 21% of parents in the United States are intentionally delaying or refusing some or all of the recommended early-childhood vaccines.

This is the first study to use Immunization Information System data to quantify the proportion of children consistently delaying receipt of vaccines. Consistent-limiting children were found to have lower levels of recommended vaccines. (Read the full article)

Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data are available on the frequency, severity, and circumstances of reactions and caretaker medical response.

This study describes food allergy reaction frequency, circumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental allergen feeding, and underutilization of epinephrine for severe reactions. (Read the full article)

Physical punishment is associated with aggression, delinquency, and internalizing conditions in childhood, as well as a range of Axis I mental disorders in adulthood. More research is needed on the possible long-term relationship between physical punishment and mental health.

To our knowledge, this is the first nationally representative examination of physical punishment and a range of Axis I and II disorders, gender interactions, and proportion of mental disorders in the general population that may be attributable to physical punishment. (Read the full article)

Siblings and other contacts of abused children, especially twins, are thought to be at higher risk for abuse than other children. However, the rate at which screening tests identify injuries in contacts is currently unknown.

Contacts of abused children with serious injuries have fractures identified on skeletal survey at significant rates. Twins are at substantially increased risk for fracture. Physical examination findings were not sensitive for fractures. (Read the full article)

Data suggest that delivery at high-volume, high-technology hospitals reduces neonatal mortality. No study has examined other complications or compared the effects in multiple states by using a study design to control for unmeasured differences in case mix.

The survival benefit to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and varies between states. The survival benefits affect both extremely and moderately preterm infants. Complication rates were similar between hospital types. (Read the full article)

Among adolescents, weight status has been inversely associated with sports participation but not active commuting or physical education. Studies of each form of physical activity have not included adequate adjustments for other physical activities, previous body weight, or diet quality.

Estimates indicate overweight/obesity and obesity prevalence would decrease by 11% and 26%, respectively, if adolescents played on at least 2 sports teams per year; obesity prevalence would decrease by 22% if adolescents walked/biked to school 4–5 days per week. (Read the full article)

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

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

Children with obstructive sleep apnea (OSA) are usually treated by surgical removal of their upper airway lymphadenoid tissue. Recently, medications were offered to patients with nonsevere OSA. Montelukast, for this indication, had never been studied in a randomized controlled manner.

Montelukast effectively reduced polysomnographic findings, symptoms, and the size of the adenoidal tissue in children with nonsevere OSA. The findings support the potential of a leukotriene modifier as a novel, safe, noninvasive alternative for children with mild to moderate OSA. (Read the full article)

Bronchiolitis is one of the most common infectious respiratory conditions of early childhood, and most children have a mild clinical course. Unfortunately, the small subgroup of children requiring continuous positive airway pressure and/or intubation remains ill-defined.

In children with bronchiolitis, we found several demographic, historical, and clinical factors that predicted the need for mechanical respiratory support including in utero smoke exposure. We also found a novel subgroup of children with bronchiolitis who have a rapid respiratory decline. (Read the full article)

Computerized provider order entry (CPOE) has been recognized to enhance the efficiency, safety, and quality of medical work. Yet vendors and organizations have not determined best practices for customizations, resulting in systems that have poor usability and unintended consequences of use.

This study demonstrated that systematically developed order sets reduce cognitive workload and order variation in the context of improved system usability and guideline adherence. The concept of cognitive workload reduction is novel in the setting of computer order entry. (Read the full article)

Policies that govern nutrition standards of foods and beverages sold outside of federal meal programs ("competitive foods") have been associated with adolescent weight status in a small number of cross-sectional studies and pre-post analyses in individual states.

This longitudinal analysis of 6300 students in 40 states provides evidence that state competitive food laws are associated with lower within-student BMI change if laws contain strong language with specific standards and are consistent across grade levels. (Read the full article)

Many children are vaccinated against measles with a delay. This may influence effective measles vaccine coverage even in countries with high overall immunization levels. Official vaccine coverage statistics do not usually report on the impact of timeliness of measles vaccination.

Delayed measles vaccination results in 48.6% effective coverage in children aged 6 months to 2 years when 84.5% of 25-month-olds are up-to-date for 1 measles vaccination. Analyzing patterns of measles vaccination could help to address low coverage in infants and toddlers. (Read the full article)

Immature animals exposed to anesthetics display apoptotic neurodegeneration and long-term cognitive deficiencies. In children, studies of cognitive deficits associated with anesthesia exposure have yielded mixed results. No studies to date have used directly administered neuropsychological assessments as outcome measures.

This study examines the association between exposure to anesthesia in children under age 3 and deficits at age 10 by using a battery of directly administered neuropsychological assessments, with deficits found in language and abstract reasoning associated with exposure. (Read the full article)

Childhood obesity is a public health concern. Although determinants of childhood overweight have been identified and their effect sizes have been calculated, prevention as well as treatment have had limited success.

We have calculated the population-based relevance of determinants of childhood overweight by using attributable risks, which can be interpreted as maximum success rates of preventive measures. New concepts were applied to estimate the relative contribution of each risk factor. (Read the full article)

Pediatric osteoarticular infections can be treated with successful microbiologic and clinical outcomes with a transition from parenteral to oral therapy. The best way to determine the timing of this transition is neither well studied nor standardized.

A total of 193 (99.5%) of 194 pediatric patients with acute bacterial osteoarticular infections were successfully transitioned to oral therapy, determined by using a combination of clinical findings and C-reactive protein levels, representing the largest single-center data set analyzed. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Few longitudinal studies from developing countries have assessed the relation between early maternal depressive symptoms and child growth beyond age 2. The results of these studies have been inconclusive.

Early maternal depressive symptoms were related to higher odds of deficits in stature but not to deficits in weight among preschool- and school-aged children. Well-child care provides opportunities to identify maternal depressive symptoms to prevent future child growth delays. (Read the full article)

Despite numerous preventive strategies including prophylaxis with 400 IU/day of vitamin D in recent years, the deficiency of vitamin D in infants is still a global health problem.

This study reveals that the risk of vitamin D deficiency is high in exclusively breastfed infants, especially in winter, despite vitamin D supplementation. Therefore, it is suggested that an adjustment of vitamin D dosage for seasonal variation might be necessary. (Read the full article)

Adult patients with neurocardiogenic syncope have shown high rates of depression. Patients with more severe depressive symptoms have higher rates of syncope recurrence. Psychiatric interventions improve quality of life and decrease syncope recurrence rates.

Children with neurocargiogenic syncope presented a 2.6-fold higher rate of clinically significant depressive symptoms compared to healthy controls. No recurrent syncope was noted during follow-up which along with improvement in family functioning predicted depressive symptoms improvement. (Read the full article)

Children born late preterm (34–36 weeks’ gestation) are at increased risk of adverse early childhood outcomes compared with term-born children. The impact of the neonatal experience on longer-term outcomes of these infants has not yet been well considered.

This study provides information regarding the development of late preterm infants at 3 years. Late preterm infants who received neonatal intensive or high-dependency care had similar developmental outcomes to children born late preterm who did not receive this care. (Read the full article)

Invasive Cronobacter infection is a rare but devastating disease known to affect hospitalized premature or immunocompromised infants fed powdered infant formulas (PIFs). PIF labels imply that powdered formulas are safe for healthy, term infants if the label instructions are followed.

Cronobacter can also infect healthy, term infants in the first months of life, even if PIF label instructions are followed. Invasive Cronobacter infection is extremely rare in exclusively breastfed infants or those fed commercially sterile, ready-to-feed formulas. (Read the full article)

School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is a widely used universal prevention strategy currently implemented in >16 000 schools across the United States. Previous research has shown positive effects on school climate and school-level discipline problems.

This study reports multilevel results on data from a 4-year randomized controlled effectiveness trial of SWPBIS in 37 elementary schools. Results indicate significant impacts on children’s aggressive behavior problems, concentration problems, office discipline referrals, emotion regulation, and prosocial behavior. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) is commonly given to premature infants with nasal prongs and nasal masks. Prongs and masks appear to injure the nose of preterm infants with equal frequency.

Nasal masks are more effective than nasal prongs for preventing intubation and mechanical ventilation in premature infants within 72 hours of starting NCPAP. (Read the full article)

Randomized controlled trials of early developmental interventions for very preterm infants demonstrate short-term benefits for infant neurobehavioral functioning. The longer-term benefits of these interventions for children and their families are not yet clear.

This randomized trial shows that home-based preventive care over the first year of life for very preterm infants has selective long-term benefits. Caregivers report less anxiety and fewer were at risk for an anxiety disorder. Preschoolers show fewer internalizing behaviors. (Read the full article)

Data from several states that have implemented protective eyewear mandates at the scholastic level have shown a substantial reduction in eye injuries. However, there are no studies that critically evaluate the effectiveness of protective eyewear in girls’ field hockey.

Data collected from regional/national high school sports injury surveillance databases by certified athletic trainers has resulted in the largest prospective national study examining the effectiveness of mandated protective eyewear in reducing head, eye/orbital, concussive, and facial injuries performed to date. (Read the full article)

Drowning is a leading cause of death for children in low- and middle-income countries. However, few childhood mortality reduction programs target drowning because of a lack of evidence on costs and effectiveness of these interventions.

This study presents the cost-effectiveness results of a low-cost injury and drowning prevention program in Bangladesh. We show that child care centers and swimming lessons are highly cost-effective interventions that could be scaled to other countries. (Read the full article)

Disparities in vaccination coverage between American Indian/Alaska Native and white children previously existed between 2001 and 2004 but were not present in 2005.

This study updates a previous study by analyzing data through 2010 and found that these gains have been maintained. (Read the full article)

With increasing survival rates, there is growing interest in long-term quality of life among patients with univentricular heart defects, and neurodevelopmental deficits play a major role in adverse outcome.

Although median cognitive performance was within normal limits, major neurodevelopmental impairment was found in one-fourth, and minor neurologic dysfunction in almost half of patients. Brain MRI showed mostly ischemic findings of different degrees in the majority of patients. (Read the full article)

Adolescents have high placebo response rates in depression treatment trials. Screening for depression will likely detect youth with a broad range of symptom severity, including some who would benefit from watchful waiting but might not require active treatment.

The strongest predictors of symptom persistence are depressive symptom severity at presentation and continued symptoms on repeat screening 6 weeks later. These results provide important information for the development of postscreening management protocols in the primary care setting. (Read the full article)

Some children with gastroenteritis fail to respond to oral rehydration. Subsequent interventions are dictated by regional preference. In North America, nasogastric rehydration is rarely administered. Caregiver and health care providers’ perspectives regarding its use have not been described previously.

Both caregivers and health care providers would select intravenous rehydration instead of nasogastric rehydration when oral rehydration fails. Greater knowledge mobilization efforts will be required for nasogastric rehydration to be adopted into clinical practice. (Read the full article)

Prenatal cocaine exposure is associated with the trajectories of childhood behavior problems. Exposure effects may also be related to maternal use of other substances during pregnancy, and risk factors other than prenatal exposure may augment the detrimental cocaine effects.

The balance between cumulative risk and protective indexes predicts behavior outcomes, independent of prenatal drug exposure. A high protective index even with a high level of risks can mitigate the detrimental effects of drug exposure on behavior problem trajectory. (Read the full article)

Very low birth weight (VLBW; <1500 g) subjects show lower scores in performance-based tests of executive functioning (EF) than control subjects up to young adulthood.

VLBW adults’ perceptions of their EF in everyday life are very similar to those of term-born adults. Parental evaluation of VLBW/small-for-gestational-age adults’ EF is more negative than adults’ self-reports. (Read the full article)

Developmental screening using standardized tools has been endorsed by professional groups to improve rates of identification and referral for young children who have developmental delays. Little is known about the effectiveness of these tools among a high-risk urban population.

Using a randomized design, we found that a program of developmental screening improved the percentage and time to identification of developmental delay, referral, and eligibility for early intervention among a poor, racially diverse urban population of young 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)

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)

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)

Preterm born children have cognitive problems that include deficits in working memory. Computer-based working memory training has been reported to improve cognitive function in children.

A computer-based working memory training program designed for preschoolers seems effective in very low birth weight children, not only on working memory tasks, but also by having a generalizing effect regarding memory and learning. (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)

Trigger scores and early warning systems provide an objective measure of a patient’s condition, allowing earlier recognition of severe illness and adaptation of care. Such scores are established in adult and pediatric populations but remain unevaluated and rarely used in neonates.

This newly designed Neonatal Trigger Score provides an objective adjunct to multidisciplinary clinical assessment in detecting unwell neonates. It is more sensitive and specific than previously validated pediatric early warning system scores. (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)

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)

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

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

Pacifiers may interfere with breastfeeding and thus are discouraged until 3 to 4 weeks of life, when they are recommended for sudden infant death syndrome risk reduction. Hospitals are restricting pacifier distribution as part of the Baby-Friendly Hospital Initiative.

We describe a temporal association between reduced exclusive breastfeeding and pacifier restriction. This observation encourages research on breastfeeding promotion and the effects of pacifiers and pacifier restriction on breastfeeding. (Read the full article)

Universal hepatitis B virus (HBV) vaccination is a cost-effective strategy to control HBV infection. Giving hepatitis B immunoglobulin to neonates of HBV carrier mothers additionally reduces transmission but is not widely used because of its expense and infrastructure requirements.

Maternal screening for hepatitis B surface antigen and hepatitis B immunoglobulin treatment of neonates of hepatitis B virus carrier mothers could be a cost-effective addition to universal vaccination in settings in which health infrastructure can support such an intervention. (Read the full article)

Excess tissue oxygenation should be avoided during neonatal resuscitation, especially in premature infants. Delivered oxygen concentrations when using a self-inflating bag (SIB) at oxygen flows <1 L/min remain to be established.

Low oxygen concentrations (30%– 40%) can be delivered with a SIB at an oxygen flow <1 L/min. A practical scheme has been developed correlating the oxygen flow rate and the corresponding delivered fraction of oxygen when using a neonatal SIB. (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)