Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.

Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. (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)

Data available before the 1990s in addition to small studies with clinical populations have shown that ocular growth and development differ between extremely preterm and term-born children.

Contemporary data on long-term visual outcomes indicate that adolescents born extremely low birth weight and/or extremely preterm exhibit more visual sensory and perceptual morbidity than adolescents born at term. (Read the full article)

Despite declines in cigarette smoking, smokeless tobacco use among youth has remained unchanged in the United States. Modified or novel smokeless tobacco products are being increasingly promoted to youth in the United States as an alternative to smoking.

Among US students in grades 6 through 12, 5.0% used snuff or chewing or dipping tobacco, whereas 2.2% used snus or dissolvable tobacco products. Approximately two-thirds of smokeless tobacco users concurrently smoked combustible tobacco; risk perception of all tobacco products was protective of smokeless tobacco use. (Read the full article)

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric has examined 30-day risk-adjusted outcomes in children’s surgery. Because of low event rates, initial efforts yielded valid models that did not meaningfully discriminate outcomes among over 20 participating institutions.

Programmatic growth, sampling algorithm refinement, and hierarchical modeling use have resulted in the ability to reliably discriminate performance among hospitals in multiple domains. We report the first actionable peer-reviewed risk-adjusted, multiinstitutional outcome data in children’s surgery. (Read the full article)

Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deficit/hyperactivity disorder (ADHD), ample evidence demonstrates that they continue to diagnose and treat this disorder suboptimally.

The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. (Read the full article)

The intestinal microbiome may play a role in immune system maturation, and it has been postulated that early-life probiotic administration may reduce the risk of allergies and asthma in childhood. To date, however, results from clinical trials have been inconsistent.

In this meta-analysis, administration of probiotics in early life may reduce total immunoglobulin E level and protect against atopic sensitization but do not seem to protect against asthma/wheezing. Future trials should carefully select probiotic strains and include longer follow-up. (Read the full article)

Phthalate exposure has been associated with insulin resistance in animal studies and cross-sectional studies of adults, but has not been studied in adolescents.

We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents. The association is highly robust to multiple sensitivity analyses, and specific to phthalates commonly found in food. Further longitudinal study of dietary phthalate exposures is needed. (Read the full article)

Effective implementation of Pediatric Emergency Care Applied Research Network head trauma rules depends on their early application. As the registered nurse (RN) is often the first to evaluate children with blunt head trauma, initial RN assessments will be an important component of this strategy.

We demonstrated fair to moderate agreement between RN and physician providers in the application of the Pediatric Emergency Care Applied Research Network head trauma rules. Effective implementation strategies may require physician verification of RN predictor assessments before computed tomography decision-making. (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)

Previous studies have reported that former late preterm infants are at increased risk for future learning and behavioral problems; thus it has been suggested that their development be closely monitored.

This population-based study indicates that the risk for attention deficit/hyperactivity disorder and learning disabilities may not be higher in former late preterm infants, and therefore intensive neurodevelopmental follow-up may not be required for all late preterm infants. (Read the full article)

Studies examining the prevalence and associated features of autistic traits (ATs) in children with ADHD with exclusionary autism spectrum disorders suggest that children with ATs exhibit more severe social and interpersonal dysfunction reminiscent of the deficits in children with autism spectrum disorders.

Our results suggest that ATs are overrepresented in ADHD children when compared with control subjects. They also suggest that the presence of ATs is associated with more severe psychopathology as well as more impaired interpersonal, school, family, and cognitive functioning. (Read the full article)

Shared decision-making involves the assessment of preferences and goals and has been prioritized in new attention-deficit/hyperactivity disorder treatment guidelines, yet no studies have examined the impact of both preferences and goals on treatment initiation.

Supporting the clinical utility of preference and goal assessment, we found that parental treatment preferences are associated with treatment initiation, and those with distinct goals select different treatments. (Read the full article)

Abusive head trauma (AHT) is a type of physical child abuse, with infants at the highest risk. Parental characteristics associated with AHT include stress, young age, and current military service. However, a comprehensive evaluation of AHT among military families is lacking.

Risk factors and rates of AHT among military families are similar to civilian populations when applying a similar definition. Infants born preterm or with birth defects may have a higher abuse risk. (Read the full article)

Rehabilitation of people with cerebral palsy aims to achieve and maintain optimal performance in mobility and daily activities. Although insight into the developmental trajectories of activities from childhood into adulthood is important, little is known about long-term development.

The gross motor function of children with cerebral palsy determines the developmental trajectories of mobility performance but not of daily activities, where intellectual disability was shown to be the determining factor. (Read the full article)

Adoptees living in Sweden are at increased risk of suicide attempt compared with nonadopted individuals, although factors mediating this risk are largely unknown. Whether adoption status represents a risk for adoptees living in the United States remains unresolved.

The odds for reported suicide attempt are elevated in US adoptees relative to nonadoptees, the first demonstration of increased risk in US adoptees placed in nonrelative families. This risk is partially mediated by other established risk factors for suicide attempt. (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)

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)

Use of complementary and alternative medicine (CAM) is increasingly common among American youth; however, information on use of CAM among youth with recurrent headache (HA) is limited.

Youth across a range of chronic conditions experience HA. These youth are more likely to use CAM. Use and expenditures for conventional medical care, and increased difficulties in activity and functioning are greater for youth with HA who use CAM. (Read the full article)

A large and growing literature has demonstrated significant associations between the use of spanking and later child aggression, but we know less about paternal spanking, effects of spanking on cognitive development, and longer-term effects.

Accounting for a broad array of risk factors, spanking predicts both aggression and receptive vocabulary across the first decade of life. Importantly, we include paternal spanking, cognitive outcomes, and a longitudinal span longer than that of much of the literature. (Read the full article)

Transition from pediatric to adult care is often reported to be unsuccessful. Little evidential research has examined the actual proportion of youth in pediatric versus adult care or impact on health status outcomes after transferring from pediatric to adult care.

Our article extends the literature by providing health transition outcome data, something that has been recognized as a critical gap to developing evidence-based programming and health care transition policy. (Read the full article)

Pertussis rates are on the rise in the United States. Infants often require hospitalization for pertussis. Vaccination can change hospitalization patterns for vaccine-preventable diseases. It is unknown if vaccinating adolescents for pertussis (recommended in 2006) might change infant hospitalization utilization.

Universal vaccination policy among adolescents against pertussis appears to have been effective in 3 of the 4 years we examined postvaccination. Further vaccination efforts among adolescents and adults are needed to prevent infantile hospitalization on a more consistent basis. (Read the full article)

Unintentional overdose and emergency department visits secondary to nonmedical use of prescription drugs are on the rise with peak age of onset in midadolescence for these risk behaviors. Also, risk behaviors, such as substance use and violence, tend to cluster.

Approximately 1 in 10 adolescents or young adults using the emergency department endorse nonmedical prescription opioid or sedative use in the past year. Rates of current opioid or sedative prescriptions are low among this group. (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)

Recent guidelines for the management of childhood pneumonia recommend narrow-spectrum antimicrobial agents (eg, ampicillin) for most children; however, few studies have directly compared the effectiveness of narrow-spectrum agents to the broader spectrum third-generation cephalosporins commonly used among children hospitalized with pneumonia.

By using data from 43 children’s hospitals in the United States, we demonstrate equivalent outcomes and costs for children hospitalized with pneumonia and treated empirically with either narrow- (ampicillin/penicillin) or broad-spectrum (ceftriaxone/cefotaxime) antimicrobial therapy. (Read the full article)

Bullying involvement is associated with deleterious psychological, educational, and health effects. However, little is known about relations between bullying involvement and sexual risk-taking behaviors or whether similar patterns hold for heterosexual and gay, lesbian, bisexual, transgendered, or questioning adolescents.

Among adolescents, bullies and bully-victims engaged in more casual sex and sex under the influence than their peers. Controlling for demographic characteristics and other victimization exposures, bully and bully-victim status predicted sexual risk taking but primarily for heterosexual adolescents. (Read the full article)

In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.

Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention. (Read the full article)

Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined.

Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk. (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)

Preterm birth is associated with increased morbidity during childhood. Many studies have focused on outcomes for preterm births before 32 weeks’ gestation, but there are few follow-up data for late preterm infants (34–36 weeks’ gestation).

The risk of respiratory admission during childhood decreased with each successive week in gestation up to 40 to 42 weeks. The increased risk is small for late preterm infants, but the number affected is large and has an impact on health care services. (Read the full article)

Several studies have suggested that very low birth weight young adults have increased risks of physical and health problems, educational underachievement, and poorer social functioning than their peers, but there are limited population-based and longitudinal data.

Former VLBW young adults in this national cohort scored as well as term controls on many measures of health and social functioning, including quality-of-life scores, with some differences largely confined to those with disability at age 7 to 8 years. (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)

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)

Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time.

This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. (Read the full article)

Early timing of puberty and affiliation with deviant friends are associated with higher levels of delinquent and aggressive behavior. Early-maturing adolescents tend to affiliate with more-deviant peers and appear more susceptible to negative peer influences.

Young early-maturing girls do not yet associate with deviant friends but are more susceptible to negative peer influences. Early puberty effects are stable over time for delinquency but dissipate for aggression. Most of these relationships are invariant across race/ethnicity. (Read the full article)

Studies assessing the accuracy of brief screening tools for postpartum depression have been conducted among adult women; however, no similar validation studies have been conducted among adolescent mothers. Accurate and valid brief depression screening tools are needed for adolescent mothers.

We found that the 10-item Edinburgh Postnatal Depression Scale (EPDS) and 2 subscales, the EPDS-7 and EPDS-2, are highly accurate at identifying postpartum depression among adolescent mothers. In pediatric settings with limited time and resources, these brief scales have potential to be used as effective depression screening tools. (Read the full article)

Early adiposity rebound is associated with future obesity and an increased risk of development of type 2 diabetes and coronary heart disease in adult life.

This study shows that early adiposity rebound is associated with future obesity and metabolic consequences of higher triglycerides, atherogenic index, apolipoprotein B, and blood pressure and lower high-density lipoprotein cholesterol at 12 years of age. (Read the full article)

Studies have shown dysfunction in the baroreflex mechanism and the autonomic nervous system, particularly in the sympathetic nervous system, in the pathophysiology of chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and syncope.

Vitamin B₁₂ deficiency is associated with postural orthostatic tachycardia syndrome in adolescence. (Read the full article)

Preterm infants dependent on parenteral nutrition are vulnerable to deficits in early postnatal nutritional intake. This coincides with a period of suboptimal head growth. Observational studies indicate that poor nutritional intake is associated with suboptimal head growth and neurodevelopmental outcome.

This study provides randomized controlled trial evidence that head growth failure in the first 4 weeks of life can be ameliorated with early nutritional intervention. Early macronutrient intake can be enhanced by optimizing a standardized, concentrated neonatal parenteral nutrition regimen. (Read the full article)

Due to reports of unintentional overdoses, in 2011 the US Food and Drug Administration finalized voluntary recommendations for dosing devices included with over-the-counter (OTC) liquid medications. The Consumer Healthcare Products Association previously endorsed similar recommendations for devices and dosing directions.

This study assessed dosing directions and devices for national brand name OTC liquid medications, available after a voluntary FDA guidance, and found high levels of adherence to most recommendations. Further improvement efforts should prioritize recommendations directly addressing potential dosing errors. (Read the full article)

Sending sexual messages and/or pictures (sexting) has been associated with sexual intercourse among high school–age students.

This study is the first to examine sexting’s prevalence among at-risk middle school students and its associations with a range of sexual behaviors. It also examines differences in sexual risk between sending sexual messages and sexual photos. (Read the full article)

Major depression is common among adolescents. The PHQ-9 has good sensitivity and specificity for detecting depression among adolescents in primary care settings. However, no study has examined the psychometric properties of the PHQ-9 among Chinese adolescents in school settings.

This is the first study to validate the use of the PHQ-9, Patient Health Questionnaire–2 item, and Patient Health Questionnaire–1 item among Chinese adolescents in Taiwan. The PHQ-9 and its 2 subscales have good sensitivity and specificity for detecting depression among school adolescents. (Read the full article)

Serum and salivary cotinine have previously been identified as reliable biomarkers for exposure to tobacco smoke.

We found that detectable serum and salivary cotinine is common among children admitted for asthma and is associated with readmission. This finding may inform clinical care for children at increased risk of asthma morbidity. (Read the full article)

Firearm injuries are the second leading cause of death among American children. Previous estimates of nonfatal injuries have relied on small samples of emergency department visits and do not allow a detailed understanding of these injuries among children and adolescents.

In 2009, there were 7391 hospitalizations for firearm-related injuries in US children and adolescents; 89% of hospitalizations occurred in males. Hospitalization rates were highest for 15- to 19-year-olds and for black males. Deaths in the hospital occurred in 6.1% of children and adolescents. (Read the full article)

The Centers for Disease Control and FITNESSGRAM BMI percentile thresholds are commonly used for obesity screening in youth. It is assumed that these thresholds are predictive of metabolic health risk, but little diagnostic data are available.

Both thresholds are predictive of metabolic syndrome, more so for boys than for girls, although with differing sensitivity and specificity. The diagnostic details of the thresholds can inform clinicians and practitioners about how these standards perform in practice. (Read the full article)

Anabolic-androgenic steroid misuse is not uncommon among adolescent boys, and initial use in adolescence is associated with a host of maladaptive outcomes, including cardiovascular, endocrine, and psychiatric complications.

This is the first known study to examine prevalence rates of anabolic-androgenic steroid misuse as a function of sexual orientation. A dramatic disparity was found, in that sexual minority boys reported misuse at a much higher rate than heterosexual boys. (Read the full article)

High sodium intake is considered an indirect cause of obesity because it is often accompanied by higher energy intake and sugar-sweetened soft drink consumption. High sodium intake is associated with increased inflammatory response in adult patients.

This study shows that high sodium intake is positively associated with adiposity, leptin, and tumor necrosis factor-α independent of total energy intake and sugar-sweetened soft drink consumption in healthy white and African American adolescents. (Read the full article)

Concerns have been raised that human papillomavirus (HPV) vaccination could lead to riskier behaviors in vaccinated adolescents, but it is unknown whether changes in risk perceptions after vaccination lead to riskier sexual behaviors.

Risk perceptions following HPV vaccination were not associated with subsequent riskier sexual behaviors in sexually experienced and inexperienced young women. These data contribute to the growing evidence that HPV vaccination does not lead to changes in sexual behaviors among adolescents. (Read the full article)

It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.

This is the first study to provide evidence that preterm infants’ exposure to adult words in the NICU before the mother’s due date are associated with better cognitive and language outcomes at 7 and 18 months’ corrected age. (Read the full article)

The majority of caffeine intake among children and adolescents is due to soda and tea consumption. Energy drinks, which provide a potent source of caffeine, have increased in availability in the United States in recent years.

This analysis presents trends in caffeine intake between 1999 and 2010, which have previously not been described in the United States, and reveals the impact of increasing energy drink use, also previously not described, on these trends among children and adolescents. (Read the full article)