There are no studies to support the clinical awareness of persistent Tanner stage (TS) 4 breast development in adulthood, and forensic experts continue to use TS 4 as evidence of age <18 years in cases of alleged child pornography.

One-fourth of nonclinical images of women over 18 years of age could be considered by a single forensic expert to represent TS 4. This observation, and substantial discordance in interpretation by pediatric endocrinologists, renders testimony based on this distinction invalid. (Read the full article)

Risk of preterm birth (PTB) has been noted to be higher for newborns with congenital heart defects (CHDs). The role of associated anomalies, whether PTB is spontaneous or medically induced, or specific categories of CHDs have not been elucidated.

By using population-based data, we found that PTB associated with CHDs was due to spontaneous PTB. Associated anomalies accounted for a small part of this increase, and there were specific associations between categories of CHDs and PTB. (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)

The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure measurement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years. (Read the full article)

Electronic cigarettes are battery-powered devices that simulate tobacco cigarettes by vaporizing nicotine and other chemicals into an inhalable mist. They have gained popularity around the world, but little is known about their safety and addictive properties.

Among Polish youth, electronic cigarettes are the fourth most common source of nicotine after cigarettes, waterpipes, and snuff. For those aged between 15 and 24 years, ever use of an electronic cigarette was 20.9%, and 30-day use was 6.9%. (Read the full article)

Inflammatory bowel disease pathogenesis is incompletely understood. Previous pediatric studies suggested associations between antibiotic use and inflammatory bowel disease development but were limited by recall bias, lack of controls, incomplete antibiotic capture, or included exposures between symptom onset and diagnosis.

Our population-based cohort study suggests that certain childhood antibiotic exposures are associated with an increased risk of developing inflammatory bowel disease. Our findings have implications for understanding the condition’s pathogenesis and provide additional stimulus for reducing unnecessary childhood antibiotic use. (Read the full article)

Infant behavioral dysregulation is a common concern, involving irritability, excessive crying, and problems with feeding and sleep. Previous research into its behavioral outcomes has been limited by small cohorts and short follow-up, and findings have been contradictory.

Long-term follow-up of a large cohort showed that infant behavioral dysregulation was a risk factor for maternal-reported behavior concerns at 5 and 14 years, but was unrelated to young adult mental health outcomes. (Read the full article)

Understanding human disease genomics requires large population-based studies. There is lack of standardization, as well as social and ethical concerns surrounding the consent process for pediatric participation in a biorepository.

The study identifies specific barriers to pediatric participation in biorepositories relative to adults, and proposes strategies to improve ethical and responsible participation of pediatric-aged patients in large-scale genomics and biorepository-driven research without significantly increasing research burden for affected families. (Read the full article)

Discussing end-of-life (EoL) care with adolescents and young adults (AYAs) is difficult. Often, such conversations are delayed or avoided, but AYAs contemplate EoL issues and want to make decisions about their care. Few established resources exist to help this process.

Results support the use of a developmentally appropriate document that allows AYAs an opportunity to share their choices about EoL care and how they would like to be remembered in the future. (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)

Healthy sleep is essential for supporting alertness and other key functional domains required for academic success. Research involving the impact of modest changes in sleep duration on children’s day-to-day behavior in school is limited.

This study shows that modest changes in sleep duration have significant impact on the behavior of typically developing children in school. Modest sleep extension resulted in detectable improvement in behavior, whereas modest sleep restriction had the opposite effect. (Read the full article)

Among middle-aged adults, genotype scores predict incident type 2 diabetes but do not improve prediction models based on clinical risk factors including family history and BMI. These clinical factors are more dynamic in adolescence, however.

A genotype score also predicts type 2 diabetes from adolescence over a mean 27 years of follow-up into adulthood but does not improve prediction models based on clinical risk factors assessed in adolescence. (Read the full article)

Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.

Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article)

Medical advances have prolonged life for children and adolescents with Duchenne muscular dystrophy (DMD), the most common inherited pediatric neuromuscular disorder. Children with this progressive disease surviving to adulthood still face significant threats to their quality of life.

Self-reported psychosocial quality of life was impaired in a significant number (57%) of boys with DMD, unrelated to their need for mobility aids. Concordance between the perceptions of parents and their sons related to psychosocial functioning was fair to poor. (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)

The impact of relative age at school entry on academic progress and the risk of being diagnosed with ADHD remains controversial. Stimulants are widely used as a therapeutic option for ADHD in the United States and increasingly in Europe.

Relative age among classmates affects academic performance among boys and girls into puberty, as well as children’s risk of being prescribed stimulants for ADHD. This should be taken into account when evaluating children’s performance and behavior in school to prevent unnecessary stimulant prescribing. (Read the full article)

Foreign-born children and adolescents in the United States experience higher tuberculosis (TB) morbidity rates than US-born children and adolescents. Pediatric risk assessment should account for country of birth, contact with a known TB case, or travel to TB-endemic countries.

Our study reports national data on parental/guardian countries of origin and international residence of pediatric patients with TB. Two-thirds of US-born children with TB have international family connections, and many have lived in countries with increased risk for TB acquisition. (Read the full article)

Pediatric tuberculosis is significant for public health professionals because it is an indicator of the recent transmission of tuberculosis in the community. Data on incidence and clinical features of pediatric tuberculosis from China are scarce.

We conducted this study to describe the patient characteristics, clinical–epidemiological profile, and treatment outcomes for pediatric tuberculosis in a referral hospital setting in China. (Read the full article)

Antimicrobials are a medication class frequently implicated in pediatric adverse drug reactions (ADRs). Trimethoprim-sulfamethoxazole (TMP-SMX) is long recognized as a contributor to the burden of these undesired and unpredictable events.

TMP-SMX ADRs increased from 2000 to 2009, with the majority of children taking the antibiotic for skin and soft tissue infections. The significant increase in TMP-SMX prescribing for these infections may result in a continued increase of associated ADRs. (Read the full article)

Knowledge is limited regarding the epidemiology of persistent pulmonary hypertension of the newborn (PPHN). Previous work has implicated a host of perinatal risk factors and a few antenatal antecedents of PPHN, including maternal consumption during pregnancy of nonsteroidal antiinflammatory medications.

In contrast to results of previous studies, we found no association between PPHN and maternal consumption during late pregnancy of nonsteroidal antiinflammatory drugs in general or ibuprofen in particular. (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)

Gaining intravenous access in children can be difficult. Recently, several near-infrared devices have been introduced attempting to support intravenous cannulation by visualizing veins underneath skin. Only one of those devices has been evaluated systemically thus far and results are inconclusive.

Although it was possible to visualize veins with near-infrared in most patients, the VascuLuminator did not improve the success of cannulation. An explanation is that the main problem is probably not localization of the vein but insertion of the cannula. (Read the full article)

There are a few longitudinal studies that suggest that attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with later psychiatric disorders, substance use disorders, and impaired work performance.

Adolescent ADHD is associated with a variety of internal and external stresses in adulthood. Consequently, it is essential to focus intervention efforts on adolescents with ADHD to prevent or alleviate adult difficulties in functioning. (Read the full article)

There is evidence that Kingella kingae, the major bacterial cause of osteoarticular infection in children <4 years of age, first colonizes the oropharynx before penetrating the bloodstream and invading distant organs. Diagnosis remains challenging because clinical findings at admission may be normal.

Our study demonstrated for the first time that a simple technique of detecting of K kingae DNA in the oropharynx can provide strong evidence that this microorganism is responsible for the OAI, or even stronger evidence that it is not. (Read the full article)

Studies have linked bullying with BMI, with overweight and obese youth vulnerable to bullying and its negative psychological and health consequences. However, there has been little comprehensive assessment of weight-based victimization, especially in weight loss treatment–seeking samples of youth.

WBV is prevalent in treatment-seeking youth, who report victimization from peers (92%), friends (70%), parents (37%), and teachers (27%). Providers should discuss WBV in their assessment and treatment of pediatric patients who are overweight or obese. (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)

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

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

Survival estimates for preterm infants are vital for counseling parents, informing care, and planning services. Widely use estimates of in-unit survival derived from a large UK population for infants born at <33 weeks’ gestational age have been available since 1999.

These survival charts have been updated and will be of use to clinicians, parents, and managers. An alternative method for graphical representation of survival probabilities is offered: contour survival plots. (Read the full article)

Current measures of risk stratification in the pediatric surgical literature are specialty specific. Although these risk scores have been validated as useful predictors of adverse outcomes, no measures currently exist to assess the full spectrum of pediatric surgery.

Our study generates a multispecialty mortality risk score for pediatric surgical patients that can be used by physicians to identify high-risk patients as well as provide a measure of risk adjustment for surgical outcomes. (Read the full article)

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)

Many studies have identified an association between television viewing and antisocial behavior, although very few have been able to demonstrate a cause-and-effect sequence. The issue of whether excessive television viewing contributes to antisocial behavior remains controversial.

Excessive television viewing during childhood and adolescence was associated with objective and subjective measures of antisocial behavior in adulthood. These associations were not explained by preexisting antisocial tendencies or other potential confounders. Excessive television appears to have long-term psychosocial consequences. (Read the full article)

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

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

UV radiation exposure in tanning beds is associated with an increased risk of skin cancer. Because of the rising rate of melanoma, the World Health Organization recommends that persons <18 years of age not use tanning devices.

Despite scientific evidence to the contrary, tanning facilities in Missouri, a state without indoor-tanning regulations, often misinformed consumers regarding the risk of skin cancer and would allow children as young as 10 years old to use tanning devices. (Read the full article)

Pediatric training programs use simulation for procedural skills training. Research demonstrates student satisfaction with simulation training, improved confidence, and improved skills when retested on a simulator. Few studies, however, have investigated the clinical impact of simulation education.

This is the first multicenter, randomized trial to evaluate the impact of simulation-based mastery learning on clinical procedural performance in pediatrics. A single simulation-based training session was not sufficient to improve interns’ clinical procedural performance. (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)

The triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) estimates atherogenic small, dense low-density lipoprotein cholesterol and predicts arterial stiffness and hard cardiovascular events in adults. Whether TG/HDL-C predicts intermediate noninvasive end points (arterial stiffness) in youth is not known.

This study is the first to document stiffer vessels in youth with higher cardiovascular risk factor–adjusted TG/HDL-C, with the effect especially strong in obese subjects. Evaluating TG/HDL-C may be helpful in identifying young subjects at risk for obesity-related atherosclerosis. (Read the full article)

Although the metabolic syndrome is associated with obesity, not all obese children have insulin resistance and metabolic syndrome, and nonobese children may develop these abnormalities. Associated factors have not been well described.

There was a 6.6% prevalence of nonobese children who were insulin-resistant, associated with a family history of hypertension. There was a 21.3% prevalence of obese who were not insulin-resistant, associated with a low waist circumference. (Read the full article)

Diuretics are used in preterm infants to treat the symptoms of bronchopulmonary dysplasia (BPD), although there is little evidence of their effectiveness in improving long-term outcomes. Prescribing patterns and frequency of diuretic use in patients with BPD are unknown.

The use of diuretics in infants with BPD, including the specific medications used and length of treatment, varies widely by institution. Long-term diuretic administration to patients with BPD is commonly practiced despite minimal evidence regarding effectiveness and safety. (Read the full article)

Although a growing body of literature suggests links between parental incarceration and negative child outcomes, research that uses representative US samples and focuses on health outcomes is limited.

Using a nationally representative US sample, we examined the association between parental incarceration and young adult mental and physical health outcomes. Results suggest childhood exposure to parental incarceration is associated with increased risk of long-term health problems. (Read the full article)

Bronchiolitis, a leading cause of infant hospitalization, has few proven treatments. A few small studies have reported the beneficial effects of a mixture of 21% oxygen + 79% helium (Heliox). The 2010 Cochrane Review concluded that additional large randomized controlled trials were needed to determine the therapeutic role of Heliox in bronchiolitis.

The Bronchiolitis Randomized Controlled Trial Emergency-Assisted Therapy with Heliox—An Evaluation (BREATHE) trial is the largest multicenter randomized controlled trial to date to investigate the efficacy of Heliox in acute bronchiolitis. The delivery method for Heliox therapy was found to be crucial to its efficacy. (Read the full article)

Most children with type 1 diabetes get care from pediatric-trained providers, and must transfer care to adult providers once in adulthood. The timing of this change in providers and its relationship to glycemic control is not well understood.

In this cohort, the estimated median age to transition to adult care was 20.1 years and 77% had left pediatric care by age 21. Leaving pediatric care was associated with a 2.5-fold increase in odds of having poor glycemic control. (Read the full article)

Parents of children with chronic cough have poor quality of life and often seek multiple consultations. There are few randomized controlled trials on the management of cough or on the efficacy of management algorithms outside of inpatient settings.

In a multicenter, trial, we found that the management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes. Earlier application of the algorithm leads to earlier cough resolution and improved parental quality of life. (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)

Studies suggest that young adults have worse access to health care, use less primary care, and visit emergency departments more frequently than adolescents. Whether these differences are present between adolescents and young adults with asthma is unknown.

Young adults with asthma were less likely to have a usual source of care and use primary care. In contrast, they were more likely to use the emergency department. Adjusting for insurance coverage reduced these differences partially but not completely. (Read the full article)

Heated, humidified high-flow nasal cannula (HHHFNC) is a noninvasive mode of respiratory support that is commonly used in the majority of US NICUs. No large randomized trial has evaluated safety or efficacy of HHHFNC.

This large randomized controlled trial suggests that HHHFNC is as effective as nCPAP for noninvasive respiratory support and can be safely applied to a wide range of neonates. (Read the full article)

Despite numerous studies, evidence of the association between food-related parenting practices and child weight remains equivocal. Examination of this association within a sample of diverse adolescents is needed to inform anticipatory guidance provided by physicians working with parents of adolescents.

The current study explores associations between food-related parenting practices and weight status in a population-based sample of parent-adolescent pairs. This diverse sample allows for an in-depth examination of the role of gender, race/ethnicity, socioeconomic status, and grade level in this association. (Read the full article)

Children are taking more medications than ever before. Medication errors in the hospital are common. Less is known about the medication errors that occur in children's homes, and there are no studies that examine the entire process.

We reviewed 963 medications in the homes of children with cancer at 3 sites. We found 3.6 errors with injury and 36 errors with potential for injury per 100 patients. Interventions should target common and dangerous errors at home. (Read the full article)

Botulinum spores are ubiquitous, found in the soil of most countries worldwide, and also in honey. It is well established that ingestion of honey by children aged <1 year can lead to infant botulism.

This study examines the prevalence of honey pacifier use among a pediatric population aged <1 year. We also assessed parental knowledge of the dangers of giving honey to children in this age group. (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)

Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-of-care ultrasound in skull fracture diagnosis.

Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care. (Read the full article)