Studies have shown that setbacks, such as receiving low school grades, lead children to experience negative self-feelings (eg, shame, insecurity, powerlessness). Psychological theory predicts that unconditional regard can buffer this adverse impact of setbacks. However, causal evidence is lacking.

This randomized field experiment shows that briefly reflecting on experiences of unconditional regard buffers children’s negative self-feelings after an academic setback 3 weeks later. Unconditional regard may thus be an important psychological lever to reduce negative self-feelings in youth. (Read the full article)

Children who suffer abusive head trauma (AHT) have lasting health and development problems. AHT can reduce life expectancy dramatically. AHT’s contribution to the burden of disease has been estimated only as part of a broad category of intentional injury.

The DALY burden of a severe AHT case averages 80% of the burden of death, with most survivors dying before age 21 years. Even mild AHT is extremely serious, with lasting sequelae that exceed the DALY burden of a severe burn. (Read the full article)

Pediatric Brain Injury Research Network investigators recently derived a highly sensitive clinical prediction rule for pediatric abusive head trauma (AHT).

The performance of this AHT screening tool has been validated. Four clinical variables, readily available at the time of admission, detect pediatric AHT with high sensitivity in intensive care settings. (Read the full article)

Fathers’ attitude and support affects breastfeeding outcomes. Fathers are currently not targeted in breastfeeding support and care provided by health care professionals. Breastfeeding interventions delivered to fathers have been shown to increase breastfeeding exclusivity and duration.

A coparenting breastfeeding support intervention delivered to mothers and fathers in the postpartum period showed beneficial effects on breastfeeding duration, paternal breastfeeding confidence, breastfeeding help provided by fathers, and mothers’ satisfaction with fathers’ involvement with breastfeeding. (Read the full article)

Exclusively breastfed newborns lose weight daily in the first few days after birth. The amount of weight lost varies substantially between newborns, with higher amounts of weight loss increasing risk for morbidity.

This study presents nomograms demonstrating percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms have potential to be used for early identification of neonates on a trajectory for greater weight loss and related morbidities. (Read the full article)

There is a debate about whether e-cigarettes will benefit public health. However, there is little knowledge about how e-cigarette users and dual users (those using both e-cigarettes and tobacco cigarettes) differ from other adolescents on a range of variables.

Teenagers who only used e-cigarettes were intermediate in levels of risk and protective factors between nonusers and those who used both cigarettes and e-cigarettes. This raises a question about whether e-cigarettes recruit low-risk youth to tobacco product use. (Read the full article)

Maternal depression has been associated with adolescent engagement in risky behaviors such as substance use. However, there is a lack of longitudinal research examining timing-specific effects in this relationship.

The results of this study indicate that youth exposed to increasing levels of maternal depressive symptoms in middle childhood are more likely to engage in substance use and delinquent behaviors and have an earlier debut age of these behaviors. (Read the full article)

Adolescent relationship abuse (ARA) is prevalent in confidential clinic settings such as school health centers (SHCs) and is associated with poor health outcomes. No evidence-based interventions target reduction of ARA in the SHC setting.

This study provides the first evidence of the potential benefits of a brief provider-delivered universal education and counseling intervention in SHCs to address and prevent a major public health problem: ARA. (Read the full article)

Exclusive breastfeeding until 6 months of an infant’s age is described as the safest, most powerful and cost-effective intervention to reduce infant morbidity and mortality globally. In developing countries, only ~25% of infants are exclusively breastfed for 6 months.

We developed a psycho-educational intervention combining education with techniques of cognitive-behavioral therapy, integrated it into the routine work of community health workers, which increased the rate and duration of exclusive breastfeeding until 6 months of an infant’s age. (Read the full article)

Pediatric obstructive sleep apnea syndrome (OSAS) has been associated with decreased health-related quality of life (QoL). Observational studies suggest that adenotonsillectomy for pediatric OSAS improves QoL, but these studies did not use a randomized study design or a control group of children with OSAS managed nonsurgically.

A prospective, randomized controlled study of adenotonsillectomy for pediatric OSAS showed significantly greater QoL and symptom improvements in children undergoing adenotonsillectomy than in the nonsurgical control arm. The extent of improvement was not appreciably influenced by baseline OSAS severity or obesity. (Read the full article)

Asthma is heterogeneous and 40% to 70% of patients fail to achieve control with current treatment strategies. To delineate relevant subphenotypes of asthma, identify key factors, and test novel interventions, comprehensive repositories linking clinical, environmental, and biologic data are required.

This is the first statewide repository for inpatient pediatric asthma. The data collected will better define asthma phenotypes, identify care practices associated with the best health outcomes, and inform personalized care plans to reduce reutilization and readmission for pediatric asthma. (Read the full article)

Previous research has established steep socioeconomic status gradients in children’s cognitive ability at kindergarten entry. Few studies have had comprehensive data to examine the contribution of a wide range of risk and protective factors across early childhood to these gradients.

Family background, health, home learning, parenting, and early care and education factors explain over half the gaps in reading and math ability between US children in the lowest versus highest socioeconomic status quintiles, suggesting a need for comprehensive early interventions. (Read the full article)

Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse health outcomes in adolescence and into adulthood. In girls, externalizing behaviors are more strongly associated with earlier FSI than internalizing behaviors.

Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Internalizing behavior at ages 8 and 10 was associated with early FSI for boys but not girls. (Read the full article)

In adults, adverse drug events account for 5% to 25% of all hospital admissions and 12% of emergency department (ED) visits of which 50% to 70% are preventable. There remains a significant gap in our understanding of the magnitude and impact of medication-related ED visits in pediatrics.

This study is the largest and most rigorous study performed evaluating the impact of medication-related visits to the ED in pediatrics and provides important information regarding the magnitude of this problem in our health care system. (Read the full article)

Universal use of conjugated pneumococcal vaccines has resulted in dramatic decline in vaccine-type invasive pneumococcal disease. However, disease is not evenly distributed, and children with underlying clinical conditions are disproportionately represented, especially among children >5 years of age.

Invasive pneumococcal disease among children with comorbidity results in higher morbidity and mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. (Read the full article)

Obstructive sleep apnea syndrome (OSAS) is associated with significant comorbidity: behavioral problems, sleepiness, and impaired quality of life. However, the utility of OSAS symptoms versus polysomnography in the prediction of comorbidities or response to treatment is not well known.

Among children with OSAS, the Pediatric Sleep Questionnaire, a well-validated, simple 1-page symptom inventory, predicts key adenotonsillectomy-responsive OSAS comorbidities and their improvement after adenotonsillectomy. In contrast, polysomnographic results do not offer similar predictive value. (Read the full article)

Noninvasive ventilation (NIV) reduced the need of intubation in preterm infants with RDS. However, randomized studies comparing nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure are still lacking.

The present study shows no differences in short-term outcomes between 2 different NIV strategies, nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure, in preterm infants for the initial treatment of RDS. (Read the full article)

Surviving infants with neonatal encephalopathy treated with hypothermia have lower rates of moderate to severe cerebral palsy and cognitive impairment at 18 to 24 months. Limited data exist on the association between cognitive functioning and neuromotor, behavioral, and school outcomes.

Although the incidence of death or IQ <55 is reduced after therapeutic hypothermia, survivors of neonatal encephalopathy with and without cerebral palsy are at elevated risk for subnormal IQ and the need for specialized educational services at 6 to 7 years. (Read the full article)

More than 70% of all preterm deliveries are late preterm (34–36 weeks of gestation). Existing evidence suggests that compared with those born at term, those born late preterm score lower on neurocognitive tests in childhood and young adulthood.

The effect of late preterm birth on neurocognitive performance persists up to late adulthood, especially among those who have only a basic or upper secondary level of education. Late preterm birth is also associated with a risk of memory impairments. (Read the full article)

Celiac disease (CD) may develop at any age. Young children with CD are at particular risk for malabsorption and failure to thrive. HLA-DR3-DQ2 homozygotes are at the highest genetic risk and develop CD very early in life.

Most children with CD detected in screening by 4 years of age have no symptoms and normal growth. Symptoms are unrelated to HLA genotype. Autoantibody levels correlate higher with severity of mucosal lesions in symptomatic as compared to asymptomatic children. (Read the full article)

The diversifying US population has led to the examination of workforce diversity and training. National data on diversity, inclusion, and cultural competency training have been previously collected but have been assessed only at the macro level of medicine.

This study assesses workforce diversity, inclusion, and cultural competency training in departments of pediatrics across the country and provides the first assessment of departmental efforts to improve diversity and inclusion and provide cultural competency training to trainees and faculty. (Read the full article)

In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis.

Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events. (Read the full article)

Pediatric palliative care (PPC) improves the quality of life for children with life-limiting illness and their families. The association between PPC and health care costs is unclear and has not been studied over time.

PPC recipients were more medically complex. Receipt of PPC was associated with lower costs when death was near but with greater costs among survivors. When controlling for medical complexity, costs did not differ significantly according to receipt of PPC. (Read the full article)

Preterm children often experience poor executive function (EF; skills underpinning adaptive, goal-directed behavior, and essential for positive academic, occupational, and social outcomes). EF matures across adolescence, but the nature and course of EF deficits for preterm adolescents is not well-described.

Extremely preterm/extremely low birthweight adolescents demonstrated small-to-medium deficits across multiple EF domains compared with normal birthweight controls. Preterm children improved on some EF aspects from age 8 to late adolescence relative to controls, but not on parent-rated behavioral EF. (Read the full article)

Collaborative care is known to be an effective system to manage child behavioral health conditions in the primary care setting.

Among urban children with attention-deficit/hyperactivity disorder, using lay care managers to address barriers to engagement with care and challenging child behaviors has the potential to improve the effectiveness of conventional collaborative care. (Read the full article)

Although treatment of infection is a mainstay of neonatal intensive care, little attention has focused on the proportion of patient antibiotic exposures validated by clinical indications that are unambiguous.

Septic workups in 127 California NICUs reveal similar burdens of proven infection, yet patient antibiotic exposures in those NICUs vary 40-fold. Because antibiotic stewardship principles dictate that antibiotic use should correlate with burden of infection, some NICUs overuse antibiotics. (Read the full article)

Otorrhea is common in children with tympanostomy tubes: annually, 2 of 3 children develop 1 or more episodes. Antibiotic-glucocorticoid eardrops are the most effective treatment in both the short- and long-term.

Treatment with antibiotic-glucocorticoid eardrops costs less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea. Non–health care costs constitute a substantial proportion of the total costs of this condition. (Read the full article)

There is concern that the Bayley-III overestimates developmental functioning in preterm populations. The ability of the Bayley-III Cognitive and Language scales to predict later functioning in very preterm children has not been examined.

The norms on the Bayley-III Cognitive and Language scales at 24 months had low sensitivity for impairment across general cognitive, verbal and nonverbal reasoning domains at 4 years, which was better detected using cut-points based on local term-born reference data. (Read the full article)

Outbreaks of serogroup B meningococcal disease occur at universities and other organizations. Until October 2014, options for control of serogroup B outbreaks were limited by the absence of a licensed vaccine for serogroup B meningococcal disease in the United States.

We describe a serogroup B outbreak at a university in 2013 and the campaign with investigational serogroup B vaccine held in response. This was the first use of a serogroup B vaccine as an outbreak response in the United States. (Read the full article)

Although waning immunity with the childhood pertussis vaccination series has been reported, there are limited data on duration of protection of the adolescent pertussis vaccine (Tdap), especially among those who have received only acellular vaccines.

This study reports that protection from Tdap wanes substantially 2 to 4 years after vaccination among adolescents who received all acellular vaccines during childhood. This waning protection is likely contributing to the increase in adolescent pertussis. (Read the full article)

Infants with an inconclusive diagnosis of cystic fibrosis after newborn screening may turn out to have cystic fibrosis. However, little is known about the incidence, characteristics (phenotype and genotype), and outcomes of these infants to guide investigations and follow-up.

In this prospective longitudinal study, a proportion (11%) of infants with an initial inconclusive diagnosis were subsequently diagnosed with cystic fibrosis. This finding underscores the need for follow-up of this population. (Read the full article)

Meaningful use (MU) incentive payments have been developed to encourage adoption and use of electronic health records (EHRs). Several studies have revealed children’s hospitals have unique barriers to the use of EHRs but were relatively early adopters of information technology.

Although a minority of children’s hospitals have succeeded with MU incentives, freestanding children’s hospitals are significantly more likely to succeed. Improvement of EHRs for pediatric use should focus on information exchange, quality reporting, and MU relevance to pediatrics. (Read the full article)

Physical activity (PA) of preschoolers has been found to be highly correlated with their child care environment. Preschool-aged children are sedentary for most of their time at child care and most are not meeting PA recommendations.

Preschoolers were presented with significantly fewer than recommended PA opportunities at child care. More active play opportunities are needed to increase PA, including more outdoor time, more teacher-led and child-initiated active play, and flexibility in naptime for preschoolers. (Read the full article)

Microcephaly is known to be associated with neurocognitive disorders and increasing head size with hydrocephalus. Head circumference is widely measured in childhood, but its practical value as a screening test is unclear.

Measured head size is not a stable characteristic and centile shifts occur very commonly, mostly reflecting measurement error or regression to the mean. Even where head size was consistently extreme, it was not a good predictor of later developmental problems. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Studies on the consequences of abnormal prenatal hemoglobin (Hb) concentration have focused on maternal morbidities and adverse birth outcomes. To date, very little is known about the association between prenatal Hb concentration and infant cognitive and motor functions.

There is an inverted U-shaped relationship between maternal Hb concentration and infant gross motor function. Hb concentration between 90 and 110 g/L appears to be optimal for early gross motor function of children. (Read the full article)

Conventional invasive pneumococcal disease (IPD) definition using laboratory confirmation lacks sensitivity. Using a vaccine-probe design, the FinIP trial showed that IPD disease burden and vaccine-preventable disease incidence were fourfold higher when a more sensitive outcome, clinically suspected IPD, was used.

Vaccine-preventable disease incidence (ie, absolute reduction due to PCV10 vaccination) during routine vaccination program was threefold with the more sensitive outcome of clinically suspected IPD compared with the conventional IPD definition. This has major implications for cost-effectiveness of PCVs. (Read the full article)

Low case volume has traditionally been associated with poor outcomes in complex surgical procedures, including pediatric liver transplantation.

This retrospective analysis supports the association between low case volume and poorer outcomes in pediatric liver transplantation, and, in addition, shows that candidates listed in low-volume centers have severely limited access to transplantation. (Read the full article)

Breastfeeding provides a protective effect against some malocclusions, and there is a strong inverse correlation between the duration of breastfeeding and the duration of pacifier use.

The protective effects of predominant and exclusive breastfeeding against malocclusion are distinct: exclusive breastfeeding reduces the risk of malocclusions regardless of pacifier use, whereas the effect of predominant breastfeeding depends on the duration of the pacifier use. (Read the full article)

Tonsillectomy guidelines make evidence-based recommendations for the perioperative use of dexamethasone, no routine use of antibiotics, and discharge education of families and for surgeons to monitor bleeding complication rates. The impact of the guidelines on processes and outcomes is unknown.

The guidelines were associated with improvement in perioperative care processes but no improvement in outcomes. Perioperative dexamethasone use increased slightly, and antibiotic use decreased substantially. Bleeding rates were stable, but revisit rates for complications increased because of revisits for pain. (Read the full article)

The US Preventive Services Task Force recommends primary care clinicians apply fluoride varnish to the teeth of all young children, but no studies have examined the effect of comprehensive preventive oral health services on children’s clinical oral health status.

Comprehensive preventive oral health services delivered by primary care clinicians can help improve the oral health of Medicaid-enrolled children, but more work is needed to link medical and dental offices to ensure the continuity of dental care for these children. (Read the full article)

Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.

It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources. (Read the full article)

Prior studies have found a positive relationship between macro-level indicators of home foreclosure and child maltreatment rates. The extent to which home foreclosure may be associated with child protective services involvement at the micro level is largely unknown.

Foreclosure filings are positively associated with child protective services involvement. However, this is true of the periods before and after a filing, which are characterized by economic and other stress, which may drive this association more than the filing itself. (Read the full article)

Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appropriate advice from multiple sources such as family and physicians.

Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; the findings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention. (Read the full article)

Interactive activities and routines promote early childhood language skills and subsequent educational achievement. Population studies describing parent-child participation in interactive activities and their associations with early child development among vulnerable populations are needed.

Significant disparities exist in parenting practices that promote child development between economically advantaged and disadvantaged parents. Participating in less interactive activities was associated with increased risk of developmental delay among low-income families, suggesting a need to enrich parenting practices. (Read the full article)

A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising.

The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children <3 years old with intracranial injury plus ≥3 features, the estimated probability of abuse is >81.5%. (Read the full article)

Street youth demonstrate elevated mortality compared with the general adolescent and young adult population. Suicide is a leading cause of death among street youth. Many street youth have experienced childhood maltreatment, including abuse and neglect.

In this prospective cohort of street youth, self-reported attempted suicide and history of childhood maltreatment were common. Individuals who experienced childhood physical abuse, emotional abuse, or emotional neglect were at highest risk of attempting suicide. (Read the full article)

Selective eating is a common, burdensome eating pattern in young children. A significant subset remain selective eaters at least until adolescence and, for some, adulthood. The question is whether selective eating is a serious enough developmental pattern to warrant intervention.

This study examines whether selective eating, at 2 levels of severity, is associated with current and future psychological problems. Because moderate levels of selective eating were associated with impairment, selective eating falls within the diagnosis of avoidant/restrictive food intake disorder. (Read the full article)

Children born very preterm (VP) or with very low birth weight (VLBW) are at risk for cognitive deficits and low IQ in childhood. Recent evidence indicates that IQ discrepancies between VP/VLBW and term-born individuals are still found in adulthood.

Development of cognitive function is more stable for VP/VLBW than term-born individuals from infancy into adulthood and can be predicted fairly well from age 20 months onward. However, when adults with cognitive impairment are excluded, group differences in stability disappear. (Read the full article)

Subjective social status (SSS), a person’s sense of their or their family’s position in the socioeconomic hierarchy, is strongly related to adult health but is not a robust predictor of adolescent health. Developmental trajectories of SSS underlying this discrepancy are unknown.

Five SSS trajectories are present in adolescence/emerging adulthood. Four stably reflect objective socioeconomic status. The fifth represents a subset of socially disadvantaged youth with "rose-colored glasses" early on. Lower SSS and membership in the fifth trajectory increase health risk. (Read the full article)