Infant and neonatal mortality rates in the United States decreased markedly during the twentieth century but have not decreased notably during recent years. There has been an increase in preterm and low birth weight births in recent years.

The lack of decrease in infant and neonatal mortality rates in recent years is due in large part to the increasing proportion of preterm and low birth weight infants, particularly infants <500 g. (Read the full article)

A gap exists with lack of programs to help mothers breastfeed. The 2012 American Academy of Pediatrics' "Policy Statement on Breastfeeding and the Use of Human Milk" re-emphasized breastfeeding as an important public health initiative rather than a lifestyle choice.

Families who receive care in a primary care setting that has implemented a "breastfeeding-friendly" office protocol may have increased rates of exclusive breastfeeding. This study evaluated an accepted clinical protocol in a large, diverse pediatric primary care setting. (Read the full article)

Some Western studies show early introduction of solid food is associated with subsequent obesity. However, introduction of solid food and obesity share social patterning, making these observations vulnerable to residual confounding.

In a non-Western developed setting, there was no clear association of the early introduction of solid food with childhood obesity. Studies in populations with a different confounding structure may be valuable in clarifying and reconciling potentially confounded epidemiologic associations. (Read the full article)

Short sleep may be an adolescent obesity risk factor, but most evidence is from cross-sectional studies. Three longitudinal studies have investigated the association between sleep duration and adolescent obesity, finding mixed results.

Shorter sleep was associated with increases in BMI from age 14 to 18, especially at the upper tail of the BMI distribution. Increasing daily sleep to 10 hours per day could help to prevent adolescent obesity. (Read the full article)

Survival of children with spinal muscular atrophy type 1 is determined by treatment choice: tracheostomy with mechanical ventilation, noninvasive mechanical ventilation, or a palliative approach. Few data are available on life expectancies with different approaches.

The present study provides data comparing therapeutic strategies that affect life expectancy. Clinicians involved in the care of patients with spinal muscular atrophy type 1 should be aware of survival trends while awaiting more definitive therapeutic strategies. (Read the full article)

The Ages and Stages Questionnaires (ASQ) has been validated in many countries and translated into numerous languages. In most publications, it has been reported that the ASQ is accurate in detecting true problems in apparently healthy children and even in children with biological risk factors.

This report compares the third version of the ASQ and the Bayley Scales of Infant and Toddler Development, Third Edition, assessments. Psychometric properties showed a tendency to improve with testing age and when comparing term versus extremely preterm children. (Read the full article)

Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.

Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. (Read the full article)

Yearly influenza immunization is recommended in patients with inflammatory bowel disease (IBD). However, concern regarding vaccine-related adverse events may limit uptake, and case reports in the literature detail disease flares after immunization.

Influenza immunization rates in children with IBD are low but immunization did not result in increased outpatient visits, hospitalizations or emergency visits. Immunization was associated with fewer IBD-related visits in the post-vaccine period, which may indicate protection against IBD symptoms. (Read the full article)

Public health policy focuses on reducing formula use for breastfed infants during the birth hospitalization. Observational evidence supports this approach, but no previous studies have examined the effect of early use of small volumes of formula on eventual breastfeeding duration.

Use of limited volumes of formula during the birth hospitalization may improve breastfeeding duration for newborns with high early weight loss. Reducing the use of formula during the birth hospitalization could be detrimental for some subpopulations of healthy term newborns. (Read the full article)

Child welfare data show declines in child physical abuse since the early 1990s, but analysis of national data from hospitalized children in the Kids’ Inpatient Database showed an increased incidence of serious physical abuse in children from 1997 to 2009.

We found no significant change in hospitalization rates for injury from abuse in young children and increases in injury severity using the National Inpatient Sample from 1997 to 2009. This data helps provide a more complete perspective of the problem. (Read the full article)

Cross-sectional studies in children and adults have reported a significant positive association between attention-deficit/hyperactivity disorder (ADHD) and obesity.

This controlled, prospective, follow-up study of boys with ADHD found significantly higher BMI and obesity rates in adulthood, compared with men without childhood ADHD, regardless of socioeconomic status and other lifetime mental disorders. (Read the full article)

Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children >12 months of age.

The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up. (Read the full article)

Atherosclerotic cardiovascular diseases are rooted in childhood. Vascular intima-media thickness (IMT) and elasticity are early surrogate markers of atherosclerosis. In adults, cardiorespiratory fitness is associated with enhanced arterial elasticity and decreased IMT.

Fitness was favorably associated with aortic IMT and elasticity in adolescents. The association was independent of several cardiometabolic risk factors. In fit adolescents, the increase in IMT during the preceding 6 years was smaller compared with low-fit peers. (Read the full article)

About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.

In this large randomized controlled trial, anticipatory guidance on the "when, what, and how" of complementary feeding was associated with increased maternal "protective" feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance. (Read the full article)

Seizure-related death, including sudden death, is a frightening prospect. In part because risk and prevention are poorly understood, neurologists tend to avoid discussions of sudden death with families and young patients.

Most deaths in children with epilepsy are not seizure related. Relative to the population, however, sudden and seizure-related deaths alone double overall mortality. In uncomplicated epilepsy, such deaths occur at rates comparable to individual leading causes of death in young people. (Read the full article)

Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.

Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. (Read the full article)

Health care professionals face problems managing obesity and often fail to follow guidelines for its management in practice. Only a few single-country reports are available describing delivery of primary care to children with obesity.

Nearly all primary pediatric care providers from 4 European countries recognize the importance of obesity in pediatric practice, but only half use BMI clinically, and many lack the confidence and the infrastructure needed for providing care to patients with obesity. (Read the full article)

Racial and ethnic differences exist in age at diagnosis and early access to mental and behavioral health services among children with autism spectrum disorders (ASDs). ASDs are also associated with increased rates of other medical comorbidities that may require specialty care.

Significant racial and ethnic differences in use of specialty care and specialty procedures exist among children with documented ASD. (Read the full article)

Obesity is associated with cardiometabolic risk factors and chronic conditions, such as type 2 diabetes. However, a proportion of overweight and obese youth remain free from cardiometabolic risk factors and are considered metabolically healthy.

This study provides insight into the determinants of cardiometabolic risk factors and the concept in health promotion of "fitness versus fatness." Hepatic lipid accumulation and not fitness level appears to drive cardiometabolic risk factor clustering among overweight and obese youth. (Read the full article)

Obstacles to vaccine delivery, including poverty, reduced access to medical care, and incomplete understanding of vaccine safety and importance, result in suboptimal coverage rates in some populations, allowing for disease outbreaks. Multicomponent interventions are successful in increasing immunization coverage rates.

We show that collaboration with local resources, including the county health department and a large community-based organization, effectively increases immunization coverage rates in low-income, resource-poor children. (Read the full article)

Brief periods of low oxygen saturation are common in infants while restrained in car safety seats. There is some evidence that an insert that allows the infant head to rest in a neutral position in sleep may reduce hypoxic episodes.

This randomized controlled study shows that the insert reduced numbers of obstructive apneas and the severity of desaturation events but did not significantly reduce the overall rate of moderate desaturations. (Read the full article)

Previous research on potential deleterious effects of typically developing children growing up in households with children with disability has produced mixed results. Research methods have been cited as a problem in many studies.

This is the largest known empirical study comparing functional impairment in siblings living with a child with disability and siblings residing with children who are typically developing. This study also follows the trajectory of functional impairment across 2 measurement periods. (Read the full article)

Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied.

Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. (Read the full article)

The number of overweight and obese children has dramatically increased in recent decades. To combat this trend, information on possible gender-related differences in risk factors of overweight and obesity is critical.

This study examines associations of gender and physiologic and behavior measurements with potential cardiovascular risk. Lunch consumption and screen time were associated with weight; however, other associations with weight differ by gender. This information can be used to tailor future interventions. (Read the full article)

At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood.

This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. (Read the full article)

Tympanometry provides a measure of middle ear function. There has been no description of the relationship between measurements of middle ear function in the absence of gross anatomic defects and clinical outcome among children with acute nontraumatic coma.

This study reveals an unexpected association between abnormal middle ear function and death in childhood acute coma. These findings call for more investigations on the relationship between middle and inner ear anatomy and function and intracranial dynamics and clinical outcomes. (Read the full article)

The incidence of pediatric pneumococcal meningitis has declined after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). It is unknown whether the frequency of severe neurologic sequelae and adverse outcomes has changed in the era of widespread PCV7 use.

Pneumococcal meningitis continues to be associated with substantial mortality and long-term morbidity. Sixty-three percent of survivors had neurologic sequelae. More than one-half of the children who were eligible for PCV7 were unimmunized at the time that they developed pneumococcal meningitis. (Read the full article)

Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)

Stuttering is extremely common, with 8.5% of children affected by age 3 years in a prospective community-ascertained cohort of Australian children. The natural history and comorbidities of early stuttering are uncertain at the population level.

The cumulative incidence of stuttering was 11% by 4 years. Stuttering children were similar in temperament and social-emotional development but had better verbal and nonverbal skills than their peers. Recovery from stuttering was low; 6.3% 12 months after onset. (Read the full article)

Adult males are known to have a greater overall likelihood of death than female adults. Among children, excess male mortality is known for specific conditions but not as a general phenomenon.

Males are more likely to die during childhood and adolescence than their female peers from not only injuries but also from a wide variety of medical conditions, suggesting the existence of either a female robustness factor or a male vulnerability factor. (Read the full article)

Pediatric early warning scores (PEWS) for hospital inpatients have been developed to identify patients at risk for deterioration. Beyond triage, similar systems that identify ill patients and predict requirements for a higher level of care are needed in the emergency department.

The validity of the different PEWS in pediatric emergency care patients has never been evaluated. This study showed that PEWS are capable of detecting children in need of ICU admission. (Read the full article)

The prevalence of overweight and obesity in US adolescents has increased over the last century. However, recent evidence indicates a potential change in this trend. Parallel trends in adolescent behaviors that drive this epidemic have not been well studied.

Analyses of recent data indicate the prevalence of overweight and obesity may be stabilizing. Over the same period, adolescent physical activity, breakfast eating, and fruit and vegetable consumption increased and television viewing and consumption of sweets and sweetened beverages decreased. (Read the full article)

Racial/ethnic differences in care for adult and pediatric patients in the emergency department have been documented.

This study reveals racial/ethnic differences in analgesic administration and prolonged length of stay for pediatric emergency department visits for abdominal pain. Documenting such disparities is an important first step needed to improve the equity of care for this and other conditions. (Read the full article)

Several studies have been published evaluating the impact of 2011 Accreditation Council for Graduate Medical Education duty hour regulations. Although resident quality of life may be improved, it appears that resident education and patient care may be worse.

This is the first study to evaluate pediatric program director approval of 2011 Accreditation Council for Graduate Medical Education Common Program Requirements and the perceived impact of the regulations on patient care, resident education, and quality of life. (Read the full article)

Caregiver behavioral symptom ratings are frequently used to assist in diagnosing childhood behavioral disorders. Although behavioral disorders are highly comorbid with learning disabilities (LDs), little work has examined the utility of caregiver ratings of learning concerns for screening of comorbid LD.

The validity of a time- and cost-efficient caregiver rating of academic concerns (Colorado Learning Difficulties Questionnaire) was examined. The screening measure accurately predicted children without LD, suggesting that the absence of parent-reported difficulties may be adequate to rule out overt LD. (Read the full article)

Physical activity (PA) levels in preschool children vary considerably between preschools, and are positively associated with the overall quality of the preschool. However, knowledge regarding specific characteristics of the preschool environment hypothesized to promote PA is inconsistent and lacking.

This study tested multiple potential correlates of preschool children’s objectively measured moderate and vigorous PA level during preschool attendance, identifying size of indoor area per child and location of preschool building on the playground as new potentially modifiable correlates. (Read the full article)

Several studies have shown that behavioral problems can be associated with defecation and voiding disorders, although few studies have looked directly at a link between a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and constipation or fecal incontinence.

We identified an increased risk for both constipation and fecal incontinence in children with ADHD. In patients with concomitant ADHD and defecation disorders, more aggressive medical and behavioral treatment of the constipation or fecal incontinence may be warranted. (Read the full article)

As more children with sickle cell disease survive into adulthood, they are increasingly hospitalized in both children’s and general hospitals and managed by different provider specialists. But it is unknown if hospital type and provider specialty affect patient outcomes.

Using a large national administrative dataset, this study revealed that general hospitals were associated with higher rates of intubation and longer lengths of stay compared with children’s hospitals for adolescents and young adults with SCD admitted with acute chest syndrome. (Read the full article)

Some studies suggest a contribution of environmental exposures such as pesticides to risk of hypospadias, whereas others do not. One of the challenges that has limited current knowledge is the lack of detailed exposure data.

This study examined a more detailed assessment of exposure to pesticides than previous studies. Exposure assignments, whether to groups of chemicals, specific chemicals, or a composite involving a number of chemicals, showed a general lack of association with hypospadias. (Read the full article)

Levels of daily physical activity in children are decreasing worldwide. This implies risk factors for cardiovascular and metabolic diseases.

Strength training makes children not only stronger but significantly increases their daily spontaneous physical activity outside the training intervention. (Read the full article)

NF1 is the commonest single-gene neurodevelopmental disorder with known neurobiology and developmental impact on attention and cognition. Its impact on social functioning is described but poorly understood, with no population-based study of autism spectrum disorder (ASD) prevalence in the disorder.

This epidemiological study shows high prevalence of 25% ASD in NF1 not explained by learning difficulties. ASD should be considered during clinical practice with NF1. Further research into NF1 as a single-gene model of ASD is warranted. (Read the full article)

Prenatal and postnatal organophosphate (cholinesterase inhibitor) pesticide exposure has been associated with delays in attention, memory, intelligence, and inhibitory control. Two recent studies reported decreased attention and working memory with greater exposure to organophosphates in boys but not in girls.

This is the first study to report associations between decreased acetylcholinesterase activity, a stable marker of cholinesterase inhibitor pesticide exposure, and lower overall neurodevelopment, attention, inhibitory control, and memory. These associations were present in boys but not in girls. (Read the full article)

Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.

In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development. (Read the full article)

Although community engagement is considered an important professional role of physicians, there has been declining involvement of pediatricians in community child health activities. Whether enhanced training is associated with increased involvement is unclear.

This study reveals a continued decline in pediatricians’ involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians’ community involvement. (Read the full article)

Adverse effects of excess weight are likely related to both obesity severity and duration. Little is known about the contribution of adolescent weight status to development of specific comorbid conditions in adults.

Severe obesity at age 18 was independently associated with increased risk of lower extremity venous edema, walking limitation, kidney dysfunction, polycystic ovary syndrome, respiratory conditions, diabetes, and hypertension in adulthood. (Read the full article)

Socioeconomic status is known to influence health and health care utilization, but few studies have explored the relationship between community-level income and inpatient resource utilization for children.

In a large sample of pediatric hospitalizations, lower community-level household income is associated with higher inpatient costs of care for common conditions. These findings highlight the need to consider socioeconomic status in health care system design and reimbursement. (Read the full article)

Screen time has risen to unprecedented levels among youth. Greater television time is known to be associated with gains in pediatric adiposity, but few studies have examined the longitudinal relations of other forms of screen-based media with weight gain.

Among adolescents aged 9 to 19 years, television viewing was the type of screen time most consistently associated with gains in BMI. However, time with digital versatile discs/videos and video/computer games was also associated with gains in BMI among girls. (Read the full article)

Pediatric surgery is performed in a variety of hospital types. General surgeons as well as fellowship-trained pediatric surgeons and surgical subspecialists perform inpatient operative procedures on infants and children. The distribution of procedures between specialists is not well characterized.

This study describes the demographics of pediatric surgery: the hospital type, the surgical procedures, and the quantity of inpatient pediatric surgery in the U.S. today. By implication, the data has much to inform health care about hospital and practitioner workforce. (Read the full article)

One study examined the incidence of obesity among low-income children aged <5 years who participated in federally funded child health and nutrition programs during 1985–1990. The study examined the variations by baseline age but not by gender or race/ethnicity.

This study provides most recent data on incidence and reversing of obesity and variations across gender, baseline age, and racial/ethnic subgroups among young low-income children. We conducted multivariable analyses to examine the relative risk of obesity in population subgroups. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health condition diagnosed in childhood, is highly heritable, and more common in boys. Although studies have identified perinatal risk factors, no one has investigated perinatal risk factors separately in boys and girls.

Contrary to other studies, low birth weight, postterm pregnancy, low Apgar scores, and fetal distress were not risk factors for ADHD irrespective of gender. Early term deliveries increased the risk of ADHD, and oxytocin augmentation in girls may be protective. (Read the full article)