Neglect cases in Child Protective Services often receive home-based interventions, but their success in preventing maltreatment recidivism has been elusive. Structured, behavioral skills models, such as SafeCare, are promising but have not been tested in full-scale implementation trials.

This cluster trial experiment demonstrates significant maltreatment recidivism reduction due to implementing the SafeCare model in a fully scaled-up statewide system. The findings support adopting the SafeCare model for these types of services. (Read the full article)

Childhood gender nonconformity has been associated with poorer relationships with parents, but it is unknown if childhood gender nonconformity is associated with childhood abuse or with posttraumatic stress disorder.

We identify gender nonconformity before age 11 years as a risk indicator for physical, sexual, and psychological abuse in childhood and lifetime probable posttraumatic stress disorder in youth. (Read the full article)

Community-acquired pneumonia (CAP) is a common pediatric illness caused by Streptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.

This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Furthermore, change in therapy did not lead to increased adverse outcomes. (Read the full article)

The number of individuals diagnosed with autism spectrum disorders (ASDs) continues to increase in the United States and other developed countries. Most prevalence estimates indicate that ASD is diagnosed less commonly in Hispanic individuals compared with non-Hispanic (NH) white populations.

Prevalence of ASD in Arizona’s population-based cohort is higher than reported previously. Prevalence in the Hispanic population and NH white population increased significantly over time, with a significant decrease in the gap between Hispanic and NH white prevalence. (Read the full article)

Studies in the Netherlands show that pubertal blockade at Tanner 2/3 prevents unwanted sex characteristics and improves psychological functioning. Endocrine Society guidelines (2009) recommend pubertal suppression for adolescents with gender identity disorder until approximately age 16.

This is the first study of a US cohort of children and adolescents with gender identity disorder. Patients were referred for medical treatment to a pediatric center that supports a multidisciplinary Gender Management Service. (Read the full article)

General measures discourage all self-referrals to the emergency department. For adults, self-referral to the emergency department has been associated with nonsevere disease, whereas severity of illness of self-referred children is still unknown.

One in four parents properly judged and acted on their febrile child’s illness by presentation to the emergency department on their own initiative. Measures to discourage parents from self-referral may potentially result in delayed or missed diagnoses. (Read the full article)

Children with special health care needs present clinically with varied functional difficulties across an array of health conditions. Little attention has been given to the interaction of these descriptors at a population level, thereby not addressing the complexity of functional difficulties and their impact on the health of CSHCN.

The data demonstrate the relationships among functional difficulties and health conditions, which then improve our understanding of CSHCN and their needs. Functional difficulties contribute significantly to outcomes, such as emergency room visits, parental work patterns, and limitations in daily activities, and have implications for practice, training, policy, and research. (Read the full article)

Rare diseases in childhood can be debilitating and require lifelong care. Since 1983, the Orphan Drug Act incentives have stimulated the development and significantly improved the availability of treatment products for patients with rare diseases.

We report an increasing pediatric orphan product designations and approvals from 2000 to 2009. The trend indicates that the Orphan Drug Act has continued to address this important unmet need. (Read the full article)

Very preterm children are at risk for developmental problems and, therefore, a systematic follow-up is important. However, the relevance of early follow-up of cognitive development has been questioned because of the divergent data on the prognostic value of early measures.

Good stability of cognitive development was found between the ages of 2 and 5 years. Well-conducted assessment of cognitive development in infancy is both reliable to anticipate later development and clinically valuable to identify those children who need developmental support. (Read the full article)

Active video games can enable children under laboratory conditions to participate in moderate, and even vigorous, physical activity. There are inconsistencies in the literature, however, about whether active video games enable children to increase physical activity under more naturalistic circumstances.

This study tests whether children receiving a new active video game spontaneously engaged in more physical activity, and whether commercially available active video games have a public health benefit. No additional physical activity was detected, suggesting no public health benefit. (Read the full article)

Few studies have examined the reliability of clinical findings in pediatric appendicitis. Clinical prediction rules are most useful if the included variables are reliable across practice settings and practitioners.

Among children who present with possible appendicitis, the interrater reliability varied considerably for patient history and physical examination variables. Those variables with the highest degree of reliability may be best suited for inclusion in appendicitis clinical prediction rules. (Read the full article)

Previous studies have identified barriers to providing optimal pediatric palliative care, including general communication issues between clinicians and family members. However, there is a paucity of data regarding the barriers specifically relating to advance care discussions.

This study identifies significant barriers to advance care discussions for children with life-threatening conditions. Clinicians perceive parental issues as the most common impediments to these discussions. Furthermore, providers believe that advance care discussions happen too late in the course of illness. (Read the full article)

Pneumonia is still a significant problem in young children from developing countries where zinc deficiency is prevalent. Although zinc supplementation reduces the risk of childhood pneumonia, the effect of adjunct zinc on severe pneumonia is unclear with conflicting results.

The overall effect, if any, of zinc as adjuvant therapy for World Health Organization–defined severe pneumonia in young children is small. (Read the full article)

Stairs are a common source of injury to children. Most injuries are minor soft tissue injuries, with the head and neck region being injured most commonly.

This is the first nationally representative study of stair-related injuries to young children in the United States. A child aged <5 years is treated in a US emergency department, on average, every 6 minutes for a stair-related injury. (Read the full article)

For children and young people with life-limiting conditions, palliative care services should be available, but few national or local data are available to estimate the burden of these conditions.

The prevalence of life-limiting conditions in children and young people in England was double the previously reported estimates, at 32 per 10 000 population. This identifies a need for specialist pediatric palliative care services. (Read the full article)

Previous research on the cost of childhood autism has been restricted primarily to studying direct costs (money outlays) incurred by publicly and privately funded service systems.

This study estimates the economic impact on the family and examines indirect costs to families in the form of parental labor market productivity losses. (Read the full article)

In the prerotavirus vaccine era, diarrhea-associated hospitalization and outpatient rates among American Indian and Alaska Native children were higher than those among the general US population. Routine rotavirus vaccination has dramatically decreased rotavirus diarrhea burden in the general US population.

Decreases in diarrhea-associated hospitalization and outpatient rates among American Indian and Alaska Native children in postvaccine years were observed in all Indian Health Service regions, with declines greater in each subsequent year after vaccine introduction. (Read the full article)

Prenatal methamphetamine exposure has been related to deficits in fetal growth, changes in infant neurobehavior, and fine motor deficits, but little is known about its developmental effects on behavior problems in early childhood.

This is the first prospective study to identify behavior problems associated with prenatal methamphetamine exposure. Mood difficulties and acting-out behavior are increased in exposed children by age 3 years. Early identification and intervention may prevent escalation into delinquency and psychopathology. (Read the full article)

Healthcare Effectiveness Data and Information Set (HEDIS) measures are widely used to assess the reliability of pediatric immunization delivery. The extent to which these measures provide accurate ("is this child up-to-date on immunizations?") and useful ("is this child due for catch-up immunizations?") information is unclear.

Overall, HEDIS childhood immunization measures are accurate and useful. Users of HEDIS data should be aware, however, that certain immunizations (eg, hepatitis B, pneumococcal conjugate) and children (eg, those with a single overdue immunization) are more prone to HEDIS misclassification. (Read the full article)

Cross-sectional studies have shown an increased risk of mental health difficulties in children with developmental coordination disorder. However, there has been limited longitudinal research in this area controlling for confounding factors and assessing the role of potential mediators.

Children with "probable" developmental coordination disorder at 7 years had a significantly increased risk mental health difficulties at 10 years. Protective factors for self-reported depression included high IQ, high self-esteem, good social communication skills, and the absence of bullying. (Read the full article)

Febrile seizure risk 7 to 10 days after measles-mumps-rubella-varicella (MMRV) is double that of separate measles-mumps-rubella (MMR) and varicella vaccines among 1-year-olds. Whether MMRV or MMR and varicella affect febrile seizure risk among 4- to 6-year-olds has not been reported.

Using Vaccine Safety Datalink data, we examined risk for febrile seizures after measles-containing vaccines. This study provides reassurance that MMRV and separately administered MMR and varicella were not associated with increased risk of febrile seizures among 4- to 6-year-olds. (Read the full article)

Subjects born preterm have higher blood pressure (BP) in childhood and adolescence. Little is known about at what age the deviation from normal BP starts, and data are especially scarce for the new generation of survivors after extremely preterm birth.

In a population-based study, we found that BP was higher in 2.5-year-old children born extremely preterm compared with controls. This finding might have implications for follow-up programs after preterm birth, with the goal of improving later cardiovascular health. (Read the full article)

Nearly one-third of all US children are overweight or obese, with even higher prevalence among Mexican American children. Overweight and obesity increase systemic inflammation, contributing to increased risk for chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease.

Obese Mexican American children had concurrent alterations in both inflammatory markers and traditional disease risk markers, relative to healthy weight children. Our results provide evidence partially explaining the health disparity for disease in Mexican American children who are overweight/obese. (Read the full article)

The presence of malodorous urine is often mentioned as one of the clinical manifestations of urinary tract infection (UTI) in young children, yet the few studies looking at this symptom are contradictory.

Our study demonstrates that malodorous urine as reported by parents increases the likelihood of UTI among young children evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI. (Read the full article)

Autism is widely considered a heterogeneous disorder in terms of etiology and phenotype. Although autism is usually a lifelong disorder, little is known about the rate or timing of how children develop regarding their communication and social functioning.

Utilizing annual evaluations for a large population of children with autism, we describe the 6 most common trajectories from diagnosis through age 14 years. Trajectories revealed considerable variation, and high socioeconomic status children were more likely to experience rapid improvement. (Read the full article)

Some but not all randomized trials have shown effects of probiotics on incidence and duration of diarrhea and respiratory tract infections among children in developing countries. Calcium improves resistance to intestinal infections in adults, but efficacy in children is unknown.

Lactobacillus reuteri DSM17938 may prevent diarrhea, especially in children with lower nutritional status. Regular calcium milk, alone or with Lactobacillus casei CRL431, did not reduce diarrhea. None of the interventions affected respiratory tract infections in these Indonesian children. (Read the full article)

Trisomy 13 and trisomy 18, common chromosomal abnormalities, are generally considered fatal within the first year after birth, although some children live longer. Little is known, however, about the inpatient medical courses of these infants and children.

Evaluation of nationally representative hospitalization data demonstrates that a significant number of children with trisomy 13 and trisomy 18 live beyond 1 year of age and that the care they receive includes both medical and surgical treatments. (Read the full article)

Nonadherence to antiretroviral therapy among children and youth with HIV is a frequent problem that can result in treatment failure and disease progression for this population. Children and adolescents face different barriers to adherence than adults infected with HIV.

Few studies have examined specific barriers to adherence as reported by children with perinatally acquired HIV and their caregivers. This report examines the agreement between child and caregiver perceptions of adherence barriers and the factors associated with these barriers. (Read the full article)

Rural Alaska children have high rates of hospitalization with lower respiratory tract infections from a variety of pathogens. Past studies of risk factors for respiratory syncytial virus infection associated medically high-risk status, household crowding, and infant feeding practices with hospitalization.

This study reveals the importance of medically high-risk status and infant feeding practices as important factors in respiratory hospitalization. In addition, we identified woodstove use and the absence of 2 or more sinks in household as risk factors for hospitalization. (Read the full article)

Cross-sectional imaging can reduce the negative appendectomy rate (NAR) in children being evaluated for suspected appendicitis; however, the ability of diagnostic imaging to decrease NAR may vary by age and gender.

Cross-sectional imaging leads to a significant reduction in NAR for children younger than 5 years and girls older than 10 years. For boys older than 5 years being evaluated for uncomplicated appendicitis, advanced imaging appears to have limited value. (Read the full article)

Cumulative social factors in childhood have been associated with obesity in adulthood. Little is known regarding the role of accumulation of social stressors and obesity in early life.

Cumulative social adversities were associated with increased odds of early-onset obesity among girls. In addition, those with a higher number of stressors at a single time period had elevated odds for obesity by 5 years of age. (Read the full article)

Evaluating dehydration severity is a challenging task. Clinical dehydration scores that combine multiple clinical findings are promising. One clinical dehydration scale score has been developed and subsequently evaluated; however, few participants in the derivation and validation studies were significantly dehydrated.

In children requiring intravenous rehydration, the dehydration scale displayed moderate reliability and weak associations with objective measures. Thus, although the scale can assist in assessing dehydration, it should not be used in isolation to dictate interventions (eg, intravenous rehydration, hospitalization). (Read the full article)

Disparities are known to exist in the prescription of opioid analgesics among racial and ethnic groups in the management of postoperative, cancer, and emergency department pain in patients across all ages, including children.

Race is associated with an unequal burden of perioperative pain and opioid adverse effects in children. Relatively, African American children had higher postoperative pain, and Caucasian children had higher incidences of opioid related adverse effects. (Read the full article)

We lack prospective studies documenting "dosage effects" of chronic child maltreatment for both subsequent adolescent and adult outcomes. It is unknown whether effects are linear, shelving, or exponential, and we lack data across domains of outcomes.

Chronic child maltreatment reports are a robust indicator of future negative health and behavioral outcomes. There is a dose-response relationship between chronicity and outcomes in adolescence, but this is attenuated in adulthood once adverse child outcomes are controlled. (Read the full article)

Following a rapid increase from 1980 to 2001, the prevalence of obesity among school-age children and adolescents in the United States has plateaued. Few studies have examined obesity trends among younger children in the past decade, and findings are inconsistent.

Among children aged <6 years at this multisite pediatric practice, the prevalence of obesity was fairly stable during 1999–2003, but substantially decreased during 2004–2008. This decrease was smaller among children insured by Medicaid than children insured by non-Medicaid health plans. (Read the full article)

Existing clinical research policy does not guarantee availability of results. Registration on the Web site ClinicalTrials.gov and the Food and Drug Administration Amendments Act improved transparency in pediatric clinical research. Registration and publication remain voluntary for many trials involving children.

Only 29% of completed registered studies and 53% of National Institutes of Health–funded trials involving children were published. Numbers of studies are increasing. Registration and posting of results on ClinicalTrials.gov should be mandatory for all studies involving children. (Read the full article)

Assessing for adequacy of supervision in the clinical setting is challenging and may result in significant variability in care. Clinicians must quickly decide if a child and family necessitate direct counseling, further intervention, or require reporting to state agencies.

This study identified the most important characteristics for the evaluation of the adequacy of supervision of a young child. A standardized scale using these characteristics may result in an efficient means to reduce variability in care. (Read the full article)

Asthma disparities exist, with Latino children of Caribbean descent at risk for poor disease control. Controller medications reduce symptoms; however, medication adherence remains suboptimal. Identifying what factors predict poor medication adherence in at-risk groups could identify important treatment targets.

This study is the first to assess objective rates of medication use among children with asthma in Puerto Rico. Findings suggest that interventions incorporating family resources and addressing parental beliefs about medications may be of benefit across cultural groups. (Read the full article)

Dimenhydrinate, an antihistaminic agent, is a widely used drug in Canada and Europe. It limits stimulation of the vomiting center via the vestibular system. Multiple studies have shown its effectiveness in the treatment of vertigo and postoperative nausea and vomiting.

Dimenhydrinate, when given orally, did not significantly decrease the frequency of vomiting in children with acute gastroenteritis compared with placebo. The reported adverse effect proportions were similar for the dimenhydrinate and placebo groups. (Read the full article)

Some researchers have suggested that individuals with Down syndrome (DS) are protected from atherosclerotic disease; however, recent data from 2 large cohort studies of individuals with DS are significant for increased mortality from ischemic heart disease and cerebrovascular disease.

This study compares lipid profiles among children with DS and their siblings, highlighting the presence of a less favorable lipid profile in this high-risk population. (Read the full article)

Despite recommendations and a universal immunization program, a recent survey reported suboptimal influenza vaccination coverage in children aged 6 to 23 months in Ontario. Little is known about predictors of coverage in young children to target immunization strategies.

Full influenza vaccination coverage in young children in Ontario is <10% and declining since the 2006–2007 season. Medically high-risk children including low birth weight infants are more likely to be immunized, but maternal and health services characteristics remain important. (Read the full article)

A single inhalation of laninamivir octanoate has previously been shown to be as effective as repeated doses of zanamivir in vitro and in vivo, but it is not known whether this is also the case for children.

Median time to fever resolution was not significantly different between laninamivir octanoate and zanamivir for pediatric patients with influenza. The severity of influenza symptoms and the frequency of complications were similar in the 2 groups. (Read the full article)

Survival of children born with Down syndrome has been improving, but few studies have used population-based data to examine the influence of fetal and maternal characteristics on survival.

This study examined predictors of survival for children born with Down syndrome using population-based data from the UK Northern Congenital Abnormality Survey and shows that year of birth, gestational age, birth weight, and presence of additional anomalies influence survival status. (Read the full article)

Most acute wheezing episodes in preschool children are associated with rhinovirus, which decreases extracellular adenosine triphosphate levels, leading to airway surface liquid dehydration and submucosal edema, which cause failure of mucus clearance. These children respond poorly to available treatments.

Hypertonic saline inhalation, a pro–airway surface liquid hydration therapy, significantly decreases both length of stay by 33% (1 day) and the absolute risk of hospitalization by 30% in preschool children presenting with acute wheezing episode to the emergency department. (Read the full article)

The association of retinal hemorrhages (RHs) with abusive head trauma (AHT) is robust; 46% to 100% RHs are reported in AHT. There is potential selection bias with risk of circular reasoning because the majority of studies describing RH focus on AHT.

This is the first prospective observational study defining prevalence and distribution of RH in critically ill children excluding those with AHT. Severe multilayered RH were rare and observed in children with accidental fatal head injury, severe coagulopathy, severe sepsis, or a combination of these factors. (Read the full article)

The hypothesis that maternal prenatal folic acid lowers risk for childhood malignancy in offspring is supported by experimental and epidemiologic evidence, including 2 Canadian ecologic studies that showed inverse associations for some cancer types in the very young.

Examining Surveillance Epidemiology and End Results Program data, a decrease in the incidence of some childhood cancers (Wilms tumor, primitive neuroectodermal tumors) was observed in those <5 years after mandatory US folic acid fortification, with stronger effects detected in infants. (Read the full article)

Observation studies and short-term prospective intervention studies have shown that physical activity positively affects the accrual of bone mass and size during growth; however, fracture risk has not been evaluated.

This study reports the long-term results of a prospective intervention with increased physical activity at a population-based level and for the first time evaluated the clinical relevant end point, fracture risk. (Read the full article)

Children with specific language impairment are at risk for social difficulties. However, whether this occurs adaptively as a result of language impairment or occurs as a result of an underlying deficit in social cognition remains unclear.

We used eye tracking to explore how children with specific language impairment view social scenes. The overall gaze behavior resembled that of typically developing children. Significant attention to the speaker’s mouth may result in receiving less social-emotional information from the eyes. (Read the full article)

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

Although obesity is correlated with levels of systolic and diastolic blood pressure, there is little evidence if the increases in obesity over the last 40 years have resulted in increased blood pressure levels.

Despite increases in obesity in Bogalusa, Louisiana between 1974 and 1993, there was no increase in systolic or diastolic blood pressure levels. It should not be assumed that trends in high blood pressure have paralleled those for obesity. (Read the full article)