Children with chronic illnesses are at risk for emotional and behavioral problems. Therefore, interventions that focus on coping with the negative consequences of the disease are needed. Evidence-based interventions are limited and often focus on a single diagnosis group.

This study demonstrates the efficacy of a cognitive-behavioral group intervention for children with various chronic illnesses. The findings indicate that the involvement of parents is important to achieve long-term results. (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)

College students with asthma tend to have worse health outcomes than their peers without asthma. Consistent use of controller medication could improve outcomes for these students, but a predictive model of appropriate use of controller medication is needed.

This study adds risk tolerance and time preference to previously studied factors of nonadherence with control medication. These preferences have substantial impacts on use of controller medication and the potential success of asthma education programs. (Read the full article)

The reasons why teens are not immunized are related to parental lack of knowledge and the need for provider recommendations.

The reasons for vaccine refusal for human papillomavirus vaccine differ from other teen vaccines, and concerns about its safety are increasing over time. (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)

Although it is known that extremely preterm children are at increased risk for cognitive deficits, academic underachievement, and behavioral problems, the frequency and severity of these impairments may decline with advances in neonatal care.

Despite recent changes in obstetric and neonatal management of extremely preterm infants, the rate of neurobehavioral impairments at school age is still too high. (Read the full article)

Chlorhexidine cleansing of the cord can reduce mortality in high-risk settings. Time to separation may increase with topical applications of chlorhexidine; 1 previous community trial quantified this increase and did not measure whether caretakers perceived the delay.

Single and multiple cleansing of the umbilical cord increases time to separation by ~50%, or an average of 2 to 2.5 days. Caretakers were able to detect this difference and expressed dissatisfaction, while still accepting the intervention. (Read the full article)

Pacifiers may interfere with breastfeeding and thus are discouraged until 3 to 4 weeks of life, when they are recommended for sudden infant death syndrome risk reduction. Hospitals are restricting pacifier distribution as part of the Baby-Friendly Hospital Initiative.

We describe a temporal association between reduced exclusive breastfeeding and pacifier restriction. This observation encourages research on breastfeeding promotion and the effects of pacifiers and pacifier restriction on breastfeeding. (Read the full article)

Racial disparities in health care have been reported in multiple settings, but not thoroughly examined at the clinician level. The frequent occurrence of respiratory tract infections allows the evaluation of differences in the management of children seen by the same clinician.

Racial differences in the management of common pediatric infections occur among children treated by the same clinician. Given persistent concerns about nonjudicious antibiotic use, examining racial differences may inform our understanding of prescribing practices and identify opportunities for intervention. (Read the full article)

Head circumference (HC) at birth reflects brain development in utero. However, HC charts used in Canada are either dated, mixed-gender, nonrepresentative of lower gestational ages, or reflective of other populations in the world.

We developed recent and gender-specific reference curves for HC at birth for singletons of 23 to 41 completed weeks’ gestational age, which included a large number of very prematurely born infants, reflecting the current geotemporal Canadian population and advances in obstetric care. (Read the full article)

In the era of widespread conjugate vaccine use, the prevalence of bacterial meningitis has declined. However, the impact of this decline on the rate of emergency department visits for viral meningitis and cost of caring for these children is unknown.

There was a decline in the rate of diagnosis of viral meningitis in US children’s hospitals between 2005 and 2011. Most children diagnosed with viral meningitis are treated with antibiotics and are hospitalized, accounting for considerable health care costs. (Read the full article)

Konzo is an irreversible sudden-onset upper-motor neuron disorder affecting children dependent on bitter cassava for food. The neuroepidemiology of konzo is well characterized. Children subsisting on poorly processed bitter cassava without adequate dietary sulfur-based amino acids are especially at risk.

We found a pervasive subclinical neurocognitive effect in children with konzo. This study provides the first evidence we are aware of that a motor proficiency examination can effectively characterize konzo severity. (Read the full article)

In the only previous cross-sectional study, the quality of pediatric guidelines was rated low on the AGREE-II (Appraisal of Guidelines for Research and Evaluation II) scale. The levels of evidence used in pediatric clinical practice guidelines have never been described.

American Academy of Pediatrics guidelines score low on the AGREE-II scale. Approximately one-quarter of recommendations are based on expert opinion or no reference. These findings support the adoption of standards for guideline development and research targeted toward unsupported recommendations. (Read the full article)

Universal hepatitis B virus (HBV) vaccination is a cost-effective strategy to control HBV infection. Giving hepatitis B immunoglobulin to neonates of HBV carrier mothers additionally reduces transmission but is not widely used because of its expense and infrastructure requirements.

Maternal screening for hepatitis B surface antigen and hepatitis B immunoglobulin treatment of neonates of hepatitis B virus carrier mothers could be a cost-effective addition to universal vaccination in settings in which health infrastructure can support such an intervention. (Read the full article)

Despite downward trends, the US teen birth rate remains among the highest of developed nations. Childhood maltreatment may place teens at higher risk, but inferences are weak given a lack of prospective study and control for alternative explanations.

Results from the first controlled, prospective study of nulliparous teenagers confirm that victims of maltreatment are more than twice as likely as their nonmaltreated peers to experience a teen childbirth after controlling for demographic confounds and other known risk factors. (Read the full article)

Adherence to infant feeding recommendations in the United States is low. The prevalence of early introduction of solid foods (<4 months of age) in the United States has been estimated to range from 19% to 29%.

Mothers’ most commonly cited reasons for early solid food introduction include perception of readiness, hunger, wanting to feed something in addition to breast milk or formula, perception of interest in solids, advice from a clinician, and to improve infant’s sleep. (Read the full article)

Excess tissue oxygenation should be avoided during neonatal resuscitation, especially in premature infants. Delivered oxygen concentrations when using a self-inflating bag (SIB) at oxygen flows <1 L/min remain to be established.

Low oxygen concentrations (30%– 40%) can be delivered with a SIB at an oxygen flow <1 L/min. A practical scheme has been developed correlating the oxygen flow rate and the corresponding delivered fraction of oxygen when using a neonatal SIB. (Read the full article)

The etiology of congenital heart defects (CHDs) is largely unknown. A few studies have suggested that maternal emotional stress around the time of conception may be related to the occurrence of CHDs.

Using a large registry-based data source from Denmark, we found that prenatal exposure to maternal bereavement, as a marker of severe stress exposure, may increase the prevalence of CHDs in offspring. (Read the full article)

Early detection for children with autism leads to better outcomes; early screening is critical. The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used instrument for early autism screening and is recommended by the American Academy of Pediatrics.

This large study provides empirical support for population screening for autism spectrum disorders and the use of the M-CHAT in primary care settings. This study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers. (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)

There are no published prospective studies on the natural course and testicular growth in early childhood of spontaneously descended testes after birth compared with scrotal or surgically treated testes in boys with congenital cryptorchidism.

Data collected from this prospective study on the natural course and growth of the spontaneously descended testes add evidence-based data and recommendations on how to clinically manage boys with congenital cryptorchidism. (Read the full article)

Extreme prematurity is a well-established cause of cognitive and motor impairment. There is some evidence that late prematurity and modifiable maternal attributes may negatively influence scholastic achievement, including standardized test performance.

We found that preterm birth significantly increases risk of first-grade failure rate even when the birth is just a few weeks before term gestation. Low maternal education status compounds the effect of prematurity. (Read the full article)

The American Academy of Pediatrics recommends neonates born at <37 weeks’ gestation receive a predischarge Infant Car Seat Challenge, meaning up to 500 000 infants qualify annually. However, little is known about incidence and risk factors for failure in this group.

This is the largest study to date to examine incidence and risk factors for failure of the Infant Car Seat Challenge. We sought to identify infants most at risk for failure to narrow the scope of testing. (Read the full article)

Clinic-based weight control programs for pediatric obesity are time and personnel intensive and not accessible to a large proportion of the population.

This is the first study to reveal the efficacy of a low-intensity, 5-month, guided self-help treatment of childhood obesity with effects on the target child’s weight immediately posttreatment and 6 months later. (Read the full article)

Medications used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children younger than 1 year. There are strong indications that GERD is overdiagnosed and overtreated.

The factors that drive overtreatment of GERD are not well understood, but it has been proposed that the use of the GERD disease label could perpetuate use of medication. In this study we find evidence for this possibility. (Read the full article)

Among adolescents younger than 15, 18% have had sex and 16 000 pregnancies occur annually; among those aged 15 to 17, 30% have had sex and 252 000 get pregnant. Information on the youngest adolescents has not been previously published.

Sexual activity and pregnancy are rare among 10-, 11-, and 12-year-olds, and sex is more likely to be nonconsensual. This arguably represents a different public health issue than sex among older teens, who have a greater need for contraception. (Read the full article)

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)

Varicella vaccine is known to be highly effective, with added benefit from a second dose.

This study demonstrates the lasting effectiveness of varicella vaccine and the benefit of the second dose. Breakthrough varicella occurred soon after vaccination, varicella rates did not increase over 14 years, and there was no increase in zoster in the cohort. (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)

Rates of screen media use have risen in parallel with rates of obesity among young people. Identifying the specific characteristics of media use that are associated with obesity can help elucidate the explanatory processes and inform effective interventions.

This study examines the associations between BMI and characteristics of media use including the type of device, duration of use, and attention to the medium. The more that participants paid primary attention to television, the higher their BMI. (Read the full article)

Early readmission of apparently healthy newborns may result from inadequate assessment of a newborn’s readiness for discharge. Knowledge of the frequency, causes, and variation in the rate of newborn readmissions may assist in developing quality improvement interventions.

Feeding problems and jaundice, both potentially preventable, are the leading causes of readmission. Late preterm and early term newborns are more likely to be readmitted and should have close follow-up after discharge from a well baby nursery. (Read the full article)

Active smoking and secondhand smoke are associated with chronic kidney disease in adults. No data are available for children.

Secondhand smoke and active smoking were associated with decreased estimated glomerular filtration rate in US adolescents. These findings support that tobacco smoke effects on kidney function begin in childhood. (Read the full article)

Delayed anaphylaxis, urticaria, and angioedema to mammalian meat products were first described in the adult population in 2009. Patients with this syndrome who consume mammalian meat typically develop symptoms 4 to 6 hours after ingestion.

Specific diagnoses for children who develop urticaria, angioedema, and idiopathic anaphylaxis are few and far between. We have now shown delayed anaphylaxis, urticaria, and angioedema due to mammalian meat products in the pediatric population. (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)

Clinically significant bleeding in pediatric immune thrombocytopenia (ITP) is rare. Evidence-based guidelines for the management of pediatric ITP recommend that patients with mild or no bleeding be followed with observation alone.

Many pediatric patients with newly diagnosed ITP continue to be managed in the inpatient setting. Bleeding events are rare in this setting. Although geographic variability exists, intravenous immunoglobulin is the most commonly used inpatient ITP treatment in the United States. (Read the full article)

Research has shown that dishware size influences self-served portion sizes and meal intake in adults. In children, larger bowls led children to request more food, but whether larger dishware affects children’s self-served portions or intake at meals is not known.

We assessed the effect of increasing dishware size on self-served portions and intake in young children. Larger plates and bowls resulted in larger self-served portions, and indirectly promoted greater intake, emphasizing the importance of age-appropriate dishware. (Read the full article)

Advances in the treatment of critically ill infants have increased survival of extremely low/very low birth weight and medically complex infants. Improved survival can result in prolonged mechanical ventilation and sometimes tracheostomy. Current tracheostomy rates for these infants are unknown.

This long-term review of infants discharged from a NICU with tracheostomies is the first to describe tracheostomy rates specifically in extremely low/very low birth weight infants. It focuses on long-term clinical outcomes and comorbidities rather than surgical complications. (Read the full article)

Forgoing artificial nutrition and hydration in children at the end of life is an acceptable practice under some circumstances. However, there is a paucity of pediatric evidence to guide health care providers’ and parents’ decision-making around this practice.

This study describes experiences of parents whose children died after forgoing artificial nutrition and hydration. All parents were satisfied with their decision and believed their child’s death was peaceful. This study adds to the limited evidence to guide clinical practice. (Read the full article)

The incidence of childhood and adolescent melanoma has been significantly increasing up to 2004. Risk factors (fair skin, light-colored hair/eyes, female gender, presence of nevi, family history, increased number of sunburns, and exposure to UV radiation) are associated with melanoma.

This study describes incidence trends of melanoma diagnosed between the ages of 0 and 19 years and from 1973 through 2009 by gender, stage and age at diagnosis, primary site, and exposure to UV radiation. (Read the full article)

Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants.

Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents. (Read the full article)

Previous studies have suggested that health care providers, family members, friends, and others play a role in shaping parents’ vaccination decisions. Other research has suggested that the media can influence whether parents decide to vaccinate their children.

Through the application of social network analysis, this study formally examines and quantifies how parents are influenced by the people and sources around them. Its findings suggest that social networks are important, particularly for parents who do not completely vaccinate. (Read the full article)

Electronic health record (EHR) uptake by US hospitals has been slow, including among children’s hospitals. The Health Information Technology for Economic and Clinical Health program, which began in 2011, offers incentives for adoption and meaningful use of EHRs.

Using an annual survey, we evaluated how children’s hospitals have progressed in EHR adoption from 2008 through the start of the Health Information Technology for Economic and Clinical Health program and assessed their ability to meaningfully use EHRs. (Read the full article)

Previous studies have found a relationship between exclusive breastfeeding for ≥6 months and iron deficiency. Little is known about the relationship between total breastfeeding duration, including the period after the introduction of complementary foods, and infant iron status.

Our results suggest that infants with longer total breastfeeding duration may be at risk for iron deficiency. Our findings highlight a clinically important association warranting additional investigation that may inform future guideline updates regarding assessment of risk for iron deficiency in young infants. (Read the full article)

Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on parent-report is associated with gross motor skills in children with cerebral palsy (CP), however this underestimates prevalence. Almost all children with severe CP have dysphagia; little is known about mild CP.

The prevalence of directly assessed OPD in preschool children with CP is 85% (70% in GMFCS I; 100% in GMFCS V). OPD was prevalent even in mild CP. Gross motor functional capacity is strongly related to dysphagia severity and prevalence. (Read the full article)

At least half of the achievement gap for low-income, minority children is present at kindergarten entry; however, there are no population-level early childhood interventions that effectively engage and support families and teachers to ameliorate the impact of adversity on achievement.

This study evaluated ParentCorps, a family-centered, school-based intervention to promote self-regulation and learning for all children entering school in disadvantaged, urban neighborhoods. ParentCorps results in higher kindergarten achievement among low-income, minority children. (Read the full article)

Antibiotics-induced rash in Epstein-Barr virus acute infectious mononucleosis, especially the aminopenicillins-induced type, was first described during the 1960s, with a reported incidence of 80% to 100%. This phenomenon was not further investigated but is well-established in pediatric textbooks.

The main observation of this study is that rash induced by amoxicillin in confirmed Epstein-Barr virus acute infectious mononucleosis was found at a rate of ~30%, which is much lower than previously reported. (Read the full article)

Cognitive and motor developmental test scores of preterm and late preterm infants increase with gestational age. Developmental test scores in full-term infants have not previously been considered to relate to gestational age.

In a cohort of healthy, full-term infants, 37 to 41 weeks, 12-month mental and psychomotor scores on the Bayley Scales of Infant Development increased with gestational age, suggesting that neurodevelopment is optimal in infants born at 39 to 41 weeks. (Read the full article)

Pulse oximetry testing in newborns can detect asymptomatic cases of critical congenital heart defects and has been added to the US Recommended Uniform Screening Panel. However, the impact that earlier diagnosis may have on survival in this population is unclear.

One-year survival for infants with critical congenital heart defects has been improving over time, yet mortality remains high. Survival has been greatest for those diagnosed after 1 day of age and may increase more with screening using pulse oximetry. (Read the full article)