Physicians have little knowledge of health care costs and charges. Studies suggest that education and awareness of hospital finances can decrease unnecessary utilization of resources. Little is known about pediatricians’ awareness of the economics of health care delivery in the inpatient setting.

Both general pediatric attending physicians and trainees acknowledged a limited understanding of hospital finances, and they demonstrated a lack of awareness of costs, charges, and reimbursements for inpatient care. (Read the full article)

Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications.

Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, β-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. (Read the full article)

Exemption rates for immunization requirements have until recently been stable in states permitting religious exemptions. States with easy exemption processes have seen higher rates of vaccine-preventable diseases.

In New York, the rate of religious exemptions has increased. Counties with higher rates of exemption have a greater incidence of pertussis. (Read the full article)

Internet, smartphones, and online social media offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.

Caregivers in an urban pediatric primary care setting have access to and frequently use the Internet, smartphones, and online social media. These technologies may help reach a traditionally hard-to-reach population. (Read the full article)

Elevated blood pressure (BP) has long-term influence on the atherosclerotic process. The relative predictive ability of the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions has not been studied.

Simplified pediatric BP tables predict risk of high adult arterial stiffness as well as the complex table does. These simple screening tools could be used for identifying pediatric subjects at risk and for intervening to improve adult cardiovascular outcomes. (Read the full article)

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

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

Monovalent rotavirus vaccine was introduced for infants in the United States in 2008. Previous US evaluations have not specifically assessed the performance of this vaccine under routine use.

Using the same methodology and covering the same time period, high effectiveness (~90%) was demonstrated for the monovalent and the pentavalent rotavirus vaccine series against rotavirus disease resulting in emergency department/inpatient care, in children up to 2 years of age. (Read the full article)

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

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

Young adult smokers frequently encounter the health care system as parents coming in for their child’s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents.

This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice. (Read the full article)

Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.

CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings. (Read the full article)

Screening for hypertension in asymptomatic children and adolescents occurs during routine care. For those with elevated blood pressure, a repeat measurement within 1 to 2 weeks is recommended. However, little is known about patterns of care after an incident elevated blood pressure.

In a population of 72 625 children and adolescents, 6108 (8.4%) had an incident elevated blood pressure. Among these, 1275 (20.9%) had their blood pressure measurement repeated within 1 month. However, few individuals with an incident elevated blood pressure subsequently developed hypertension. (Read the full article)

Language barriers adversely affect health care access, utilization, outcomes, and patient safety. Trained formal interpreters can improve care quality and safety, but many patients and families with limited English proficiency do not receive appropriate language services during health care encounters.

Despite continued growth of the US population with limited English proficiency, federal language use standards, and enhanced education about appropriate use of language services, there has been only modest improvement over time in pediatricians’ use of language services. (Read the full article)

Patients with hereditary angioedema (HAE) have recurrent episodes of painful swelling. Several new therapies to prevent and treat HAE attacks are approved by the Food and Drug Administration, but their safety and efficacy in children are largely unknown.

Ecallantide appears effective for treatment of HAE attacks in pediatric patients age 10 to 17 years with an acceptable safety profile. It represents a potential treatment option for adolescents with HAE. (Read the full article)

The natural history of asthma during adolescence is dynamic because both remission and relapse are common. Remission has consistently been associated with mild asthma and the absence of sensitization.

One in 5 children with asthma remitted from age 7 to 19. Remission was defined as no wheezing and no medication for ≥3 years and was inversely related to female gender, sensitization to furred animals, and asthma severity at baseline. (Read the full article)

Although studies have examined family socioeconomic status as income and educational and employment status, emerging research suggests indicators of material hardship, such as diaper need, are increasingly important to child health. Diaper need has not been examined in the scientific literature.

This study quantifies diaper need, proposes a method to measure diaper need, and explores psychosocial and demographic variables associated with diaper need in a large sample of low-income families. (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)

Respiratory outcomes of patients with bronchopulmonary dysplasia (BPD) range from no oxygen requirement to chronic respiratory failure. Outcomes of least severe types of BPD are well described. Limited data exist on outcomes of patients with BPD-related chronic ventilator dependency.

Along with a first estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were dependent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation. (Read the full article)

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

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

Latino children are diagnosed with autism spectrum disorders (ASDs) less often and later than white children. Primary care pediatricians (PCPs) may play an important role in early ASD identification for Latinos.

PCPs find it more difficult to assess for ASDs in Latinos with Spanish primary language, view Latino parents as less knowledgeable about ASDs, and experience frequent barriers to ASD diagnosis in Latino patients. Many PCPs do not offer recommended screenings in Spanish. (Read the full article)

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

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

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

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

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

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

Pulmonary embolism (PE) in the pediatric population is rare but does occur and is underrecognized. In adult emergency medicine, there are validated clinical decision rules derived to provide reliable and reproducible means of determining pretest probability of PE.

There are known risk factors, signs, and symptoms that should raise the clinician’s suspicion of pulmonary embolism, even in the pediatric population. (Read the full article)

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

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

Pediatric myasthenia encompasses a group of rare and underdiagnosed conditions affecting the neuromuscular junction. Symptoms include fluctuating skeletal muscle weakness, which can progress to respiratory failure if left untreated. The autoimmune form of this condition, in particular, is treatable.

This study describes the incidence, clinical features, diagnostic testing, and treatment trends of pediatric myasthenia in Canada, which have not been previously reported in the literature. (Read the full article)

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

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

Childhood interstitial lung diseases occur in a variety of clinical contexts and are associated with high morbidity and mortality. Advances in the understanding of disease pathogenesis and use of standardized terminology have facilitated increased case ascertainment.

This study demonstrates that cases of newly described forms of childhood interstitial lung diseases likely occur at all children’s hospitals. With advances in genetic testing and recognition of imaging patterns, a significant portion of cases are identifiable with noninvasive evaluations. (Read the full article)

Previous studies have shown that nonmedical exemptions (NMEs) to immunization cluster geographically and contribute to outbreaks of vaccine-preventable diseases such as pertussis. The 2010 pertussis resurgence in California has been widely attributed to waning immunity from acellular pertussis vaccines.

This study provides evidence of spatial and temporal clustering of NMEs and clustering of pertussis cases and suggests that geographic areas with high NME rates were also associated with high rates of pertussis in California in 2010. (Read the full article)

Stress affects health of children, potentially persisting as a trajectory into adulthood. Earlier biological markers assess only momentary stress, making it difficult to investigate stress over longer periods of time. Cortisol in hair is a new biomarker of prolonged stress.

Mother and child hair cortisol association suggests a heritable part or maternal calibration. Cortisol output gradually stabilizes, has a stable trait, and is positively correlated to birth weight. Hair cortisol is a promising noninvasive biomarker of prolonged stress, especially applicable for children. (Read the full article)

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

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

Lower risk of early celiac disease (CD) has been observed with breastfeeding and low dose of gluten at introduction. Gluten introduction before 4 or after 6 months has been associated with increased risk. For CD diagnosed after 2 years, the association is unclear.

Gluten introduction delayed to >6 months as well as breastfeeding >12 months was associated with a modest increase in CD in this first population-based birth cohort study, and gluten introduction under continued breastfeeding was not protective. (Read the full article)

End-stage kidney disease (ESKD) causes significant morbidity and mortality after solid organ transplantation. Adults commonly develop advanced kidney disease, particularly after liver and intestinal transplantation. Previous pediatric studies have not compared the relative incidence of ESKD by organ type.

This national cohort study shows the highest risk of ESKD among pediatric lung and intestinal transplant recipients, reflecting unique organ-specific causes of kidney injury. Our findings have implications for screening for and treating early kidney disease in transplant recipients. (Read the full article)

Pediatric functional abdominal pain is common and costly. Cognitive behavior therapy (CBT) is a promising treatment for these complaints, but solid evidence for its effectiveness is lacking.

This randomized controlled trial shows that CBT reduces abdominal pain in 60% of children 1 year after treatment. Six sessions of CBT delivered by trained master’s students in psychology were equally effective as 6 visits to an experienced pediatrician. (Read the full article)

Higher-hazard, no-benefit research involving children may be approved by local institutional review boards only when the protocol enrolls children with the medical condition under study. The ethics of this distinction have been debated, but parental opinions have not been explored.

We found that parental opinions support federal regulations. We discuss parental motivations for and against research participation and the extent to which enrolling a child in higher-hazard, no-benefit research reflects appropriate surrogate decision-making. (Read the full article)

Obesity and overweight can seriously affect health outcomes. Many obesity prevention interventions have been proposed, but few have been effective. Motivational interviewing in primary care seems promising, but results in BMI control are controversial and require further investigation.

This is the first study to demonstrate the effectiveness of pediatrician-led motivational interviewing for BMI control in overweight children aged 4 to 7 years. Nevertheless, no effect was observed in boys or when the mother’s education level was low. (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)

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

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

Although providing improved survival for infants with very severe cardiorespiratory problems, the use of neonatal extracorporeal membrane oxygenation has high rates of disability in survivors. Mild hypothermia has been shown to limit brain injury in a range of patient groups, including newborns.

Infants who received extracorporeal membrane oxygenation and mild hypothermia did not show an improved neurodevelopmental outcome, and nonsignificant trends in the data suggested a small adverse effect. Use of hypothermia in other potential patient groups should be thoroughly tested. (Read the full article)

Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders.

Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy. (Read the full article)

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

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

Previous studies have found links between prepregnancy BMI and/or pregnancy weight gain and autism spectrum disorders (ASD) risk. Several contributing factors to BMI and pregnancy weight gain (ie, prematurity, advanced maternal age, parental education, and parity) overlap with established ASD risk factors.

This study identifies an association between ASD risk and prenatal weight gain, but not prepregnancy BMI, and accounts for important confounding variables excluded in previous analyses. It provides the first within-mother comparison of these factors by including unaffected sibling controls. (Read the full article)

Influenza-associated deaths in children occur every year among children of all ages. Young children and those with high-risk medical conditions are at higher risk of influenza-related complications.

This study describes influenza-associated pediatric deaths over 8 influenza seasons in the United States and compares characteristics of deaths in children with high-risk medical conditions with those in children without high-risk medical conditions. (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)

Over the past 10 years, children’s hospitals increasingly have established pediatric palliative care programs, but little is known about the prevalence of these programs or their geographic distribution, range of services offered, staff composition, or funding.

Among the 162 hospitals that responded to this survey (71.7% response rate), 69% have a pediatric palliative care program, with substantial variation across programs in terms of how they are staffed and funded and what services they provide. (Read the full article)

An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child’s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.

How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination. (Read the full article)

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

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

Certain characteristics of the sleep environment increase the risk for sleep-related, sudden, and unexplained infant death. These characteristics have the potential to generate asphyxia. The relationship between the deaths occurring in these environments and neurochemical abnormalities in the brainstem that may impair protective responses to asphyxia is unknown.

We report neurochemical brainstem abnormalities underlying cases of sudden infant death that are associated with and without potential asphyxial situations in the sleep environment at death. The means to detect and treat these abnormalities in infants at risk are needed. (Read the full article)

Young age at first sexual intercourse (FSI) is related to risk-taking behaviors and negative outcomes. Previous studies using a cohort or cross-sectional design have concluded that younger age at menarche (AAM) is related to younger age at FSI.

This large birth cohort study is the first to address the temporal relationship between AAM and FSI. We found that younger AAM does not confer higher risk of early FSI, whether in terms of calendar age or time since menarche. (Read the full article)