Critics argue that pediatric research without the potential for clinical benefit treats children as mere means to benefit others. Yet, there are no data to assess whether adolescents who participate in research, or their parents, agree with this view.

Respondents felt that by participating in research the adolescents were making important contributions to help others, and the adolescents felt proud to be doing so. These findings support the view that nonbeneficial pediatric research involves a type of charitable activity. (Read the full article)

Although the natural course of bilirubin levels has been extensively studied in general neonatal populations, there is a paucity of data regarding bilirubin trends in neonates before the development of significant hyperbilirubinemia.

This study provides data on the natural course of transcutaneous bilirubin before the development of significant hyperbilirubinemia, and on the effect of different demographic and perinatal risk factors on the rate of bilirubin increase in neonates with borderline bilirubin values. (Read the full article)

Pediatric osteoarticular infections can be treated with successful microbiologic and clinical outcomes with a transition from parenteral to oral therapy. The best way to determine the timing of this transition is neither well studied nor standardized.

A total of 193 (99.5%) of 194 pediatric patients with acute bacterial osteoarticular infections were successfully transitioned to oral therapy, determined by using a combination of clinical findings and C-reactive protein levels, representing the largest single-center data set analyzed. (Read the full article)

A 2001 survey of pediatric residency training directors indicated that few programs prepared residents to intervene on tobacco. A decade later, it is not known whether programs are doing more to prepare residents to intervene effectively with patients and parents.

Despite the need for pediatricians to play a leadership role in tobacco prevention and control, most pediatric residency training programs focus more on health effects of tobacco use and smoke exposure than on how to intervene with patients and parents. (Read the full article)

Fever phobia is a ubiquitous problem throughout the world. As a result, fever is pharmacologically overtreated, and medical attention is frequently sought by worried parents.

Most Canadian parents fear their child’s fever, resulting in aggressive surveillance and treatment. Parents expect information about fever etiology and how to care for their ill child. Few parents expect antibiotics and satisfaction with care is high. (Read the full article)

Iatrogenic medical errors are an important medical care issue in the United States. Errors may be particularly important in children with chronic health conditions, especially as the prevalence of chronic conditions is increasing in children.

In a nationally representative sample, we found that pediatric inpatients with chronic conditions were at a significantly higher risk for medical errors than inpatient children without chronic conditions, controlling for severity of illness, length of stay, and other potential confounders. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Sending and receiving sexually explicit picture and text messages via cell phone (ie, "sexting") among adolescents is publicized as a societal and public health concern, yet it is unknown whether sexting is associated with physical sexual activity or sexual risk behavior.

This study is the first to examine sexting among a probability sample of adolescents and found that sexting is associated with sexual activity, sexual risk behavior, and knowing other person(s) who have sent a sext. (Read the full article)

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

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

Expedited partner therapy (EPT) is an effective method of partner treatment of sexually transmitted infections but is not used frequently. There are limited data on provider knowledge, practices, and comfort with EPT use in adolescents.

California pediatric residents have knowledge gaps and discomfort providing EPT and presence of an adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Our findings support the need to improve EPT education in pediatric residencies. (Read the full article)

Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care.

This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. (Read the full article)

Implementing expanded vaccination recommendations has challenged primary care providers, who administer the majority of vaccines in the United States. School-located vaccination has been proposed as a means of increasing vaccination rates while reducing the burden on primary care providers.

This study assesses physicians’ support for their patients’ receipt of vaccines in school. Additionally, it compares physicians’ support for adolescent versus influenza vaccination and compares support by insurance status of their patient. (Read the full article)

There are limited data regarding the current status of the pediatric clinical trial enterprise.

Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible. (Read the full article)

The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.

The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting. (Read the full article)

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

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

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

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

Oral health researchers and policy makers primarily use 4 national surveys to examine use of dental services among US children. Estimates from the surveys may vary, posing a challenge to population-based monitoring.

The authors of this study compared estimates of dental service use and delayed dental care obtained from 4 commonly used health surveys to appraise their utility for guiding pediatric oral health research and policy. (Read the full article)

The false-positive rate of newborn screening for classic congenital adrenal hyperplasia (CAH) remains high and has not been significantly improved by adjusting 17α-hydroxyprogesterone cutoff values for birth weight and/or gestational age. In response, 4 states have initiated second-tier steroid profile screening.

Under second-tier screening, the false-positive rate remains high, and classic CAH cases missed by screening (false-negatives) occur more frequently than reported. Physicians are cautioned that a negative screen does not necessarily rule out CAH. (Read the full article)

Several meta-analyses evaluating probiotics in preterm infants suggest a beneficial effect for the prevention of necrotizing enterocolitis and death, but less for nosocomial infection. Lactobacillus reuteri may reduce these outcomes because of its immunomodulation and bactericidal properties.

Although L reuteri did not appear to decrease the rate of death or nosocomial infection, the trends suggest a protective role consistent with the literature. Feeding intolerance and duration of hospitalization were significantly decreased in premature infants ≤1500 g. (Read the full article)

Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder of presumed autoimmune or autoinflammatory etiology predominantly affecting children. There are limited data on the characteristics and optimal treatment of CNO in the United States.

A US-based cohort of pediatric CNO patients revealed high rates of personal and familial autoimmunity. Coexisting autoimmunity was a risk factor for widespread involvement. Response to nonsteroidal antiinflammatory drugs was inferior to that with immunosuppressive and biologic agents. (Read the full article)

Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.

US boys appear to be developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys. (Read the full article)

There are limited data on current testing and treatment patterns for children hospitalized with pneumonia, and on whether institutional guidelines affect care.

The use of institutional clinical practice guidelines was not associated with changes in diagnostic testing, hospital length of stay, or costs for children hospitalized with pneumonia, but was associated with increased use of narrow-spectrum antibiotics. (Read the full article)

The CPT1A p.P479L variant is common to northern aboriginal populations, leads to reduced enzyme activity, and may be associated with increased infant mortality rates.

The p.P479L variant is common in British Columbia First Nations with a coastal distribution correlated with regions of high infant mortality. Homozygotes display an altered acylcarnitine profile and are overrepresented in cases of sudden unexpected infant death in these areas. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) is commonly given to premature infants with nasal prongs and nasal masks. Prongs and masks appear to injure the nose of preterm infants with equal frequency.

Nasal masks are more effective than nasal prongs for preventing intubation and mechanical ventilation in premature infants within 72 hours of starting NCPAP. (Read the full article)

Postnatal growth restriction of preterm infants is a universal problem. Early "catch-up growth" has been associated with development of metabolic syndrome. In addition, preterm infants appear to be at major risk for developing increased adiposity and insulin resistance.

The consumption of a nutrient-enriched formula after hospital discharge may be beneficial in adequate for gestational age infants both in terms of head circumference growth and fat-free mass gain. (Read the full article)

Randomized controlled trials of early developmental interventions for very preterm infants demonstrate short-term benefits for infant neurobehavioral functioning. The longer-term benefits of these interventions for children and their families are not yet clear.

This randomized trial shows that home-based preventive care over the first year of life for very preterm infants has selective long-term benefits. Caregivers report less anxiety and fewer were at risk for an anxiety disorder. Preschoolers show fewer internalizing behaviors. (Read the full article)

It has been widely thought for the past 20 years that recurrent low blood glucose levels ≤2.5 mmol/L (45 mg/dL), even in the absence of any suggestive clinical signs, can harm a preterm infant’s long-term development.

This prospective study showed the outcome at 2 and 15 years later for the preterm infants who had a blood glucose level this low in the first 10 days of life did not differ from that of matched controls. (Read the full article)

Pediatric specialists are increasingly involved in prenatal care, particularly for congenital fetal conditions. Questions remain about pediatricians’ role in the management of maternal conditions that may affect postnatal health, and the attitudes of obstetric and pediatric specialists around such care.

Obstetric and pediatric specialists’ attitudes differ substantially regarding pediatricians’ role in providing consultation for maternal conditions that may affect a child’s health postnatally, and regarding whether court authorization may be appropriate when a woman refuses certain treatment recommendations. (Read the full article)

There is concern about the potential exploitation of children who are enrolled into clinical trials in developing and transition countries. Previous studies of globalization have only examined pediatric drug trials, and only 1 study has provided patient-level data by country.

The involvement of developing and transition countries depends on the product or indication under investigation and is greater for vaccines than for drugs or biologicals. Compared with our previous analysis, involvement of these countries in pediatric drug development has decreased. (Read the full article)

Interventions to reduce screen time in preschool-aged children are promising.

A screen time intervention in 3-year-old children implemented in the primary care setting did not reduce screen time or BMI. (Read the full article)

Stressful events adversely affect the immune system, particularly the natural killer (NK) cells. Infants in the NICUs are exposed to stressful stimuli. The effect of massage therapy on the immune system of preterm infants has not been investigated.

This randomized placebo-controlled study found daily massage performed in stable preterm infants for a minimum of 5 days was associated with an increase in NK cell cytotoxicity despite lower absolute NK cell numbers compared with controls. (Read the full article)

Previous studies have revealed misconceptions among pediatric patients, their families, and athletic coaches surrounding concussion. Little is known about pediatric primary care and emergency medicine providers’ attitudes and beliefs about diagnosis and management of this mild traumatic brain injury.

Although pediatric primary care and emergency medicine providers regularly care for concussion patients and value their role in management, they may not have adequate training or infrastructure to systematically diagnose and manage these patients. (Read the full article)

In a previous randomized trial, infants from a low-resource country exclusively breastfed for 6 months had lower iron stores at 6 months compared with breastfeeding infants receiving solid foods. Randomized trials of exclusive breastfeeding in high-income countries are lacking.

In a high-income country, infants who receive complementary foods in addition to breast milk from 4 months of age had higher iron stores at 6 months compared with those exclusively breastfed for 6 months. (Read the full article)

Information is limited on adoption of fully functional electronic health records (EHRs) in office-based pediatric practices, such as rates of adoption, barriers to adoption, and features that pediatricians choose.

A nationwide survey of members of the AAP in 2009 found that pediatric adoption of fully functional EHRs lags general adoption. Barriers include financial and productivity concerns, but pediatricians are also concerned about finding systems that meet their specific needs. (Read the full article)

Disparities in vaccination coverage between American Indian/Alaska Native and white children previously existed between 2001 and 2004 but were not present in 2005.

This study updates a previous study by analyzing data through 2010 and found that these gains have been maintained. (Read the full article)

Doxorubicin therapy, effective against many malignancies, is limited by cardiotoxicity. Continuous-infusion doxorubicin, compared with bolus-infusion, reduces early cardiotoxicity in adults. Its effectiveness in reducing late cardiotoxicity in children remains uncertain.

This multicenter randomized trial assessed whether continuous-infusion of doxorubicin in pediatric patients provides long-term cardioprotection or improvement in event-free survival over bolus-infusion in acute lymphoblastic leukemia. Continuous-infusion of doxorubicin provided no cardioprotection or improvement in event-free survival. (Read the full article)

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

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

High doses of radiation have been linked to cancer induction in irradiated populations such as atomic bomb survivors. Medical imaging directs significant radiation doses to human tissues. Epidemiological studies have demonstrated that children are more sensitive to radiation than adults.

The link between cancer induction from moderate radiation doses such as diagnostic imaging is controversial. This study uses Food and Drug Administration–accepted formulas to calculate theoretical risk of breast cancer induction in female pediatric trauma patients receiving diagnostic imaging of the thoracic spine. (Read the full article)

A previous study of inflatable bouncer–related fractures has shown that upper extremity fractures are most common, and many fractures are caused by collisions; however, no study has examined nonfracture injuries or used nationally representative data to investigate inflatable bouncer–related injuries.

This is the first study to use nationally representative data to calculate national injury rates, assess risk factors, and examine trends for pediatric inflatable bouncer–related injuries treated in US emergency departments over a 21-year period (1990–2010). (Read the full article)

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

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

Medical imaging that uses ionizing radiation provides notable benefits in the clinical setting. Controversy regarding increased cancer risk, particularly in children, dictates that ordering practices and use of such medical imaging be evaluated to reduce unnecessary exposure to imaging-related radiation.

We evaluated the prevalence and characteristics of diagnostic imaging procedures in children. The proportion of higher radiation procedures is increasing, especially among children evaluated in the inpatient and emergency department settings and those with gastrointestinal and neurologic symptoms, and congenital anomalies. (Read the full article)

Obesity is a risk factor for failure to initiate breastfeeding, formula supplementation, and short breastfeeding duration. There is a need for interventions that can improve the breastfeeding outcomes of overweight and obese women.

Breastfeeding peer counseling targeting overweight/obese women did not affect exclusive breastfeeding rates or breastfeeding continuation beyond 2 weeks. However, the intervention was associated with improvements in early breastfeeding intensity and fewer infant hospitalizations in the first 6 months after birth. (Read the full article)

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

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

Cerebral edema (CE) occurs frequently during treatment of diabetic ketoacidosis (DKA) in children. Severe, life-threatening CE occurs rarely, but subclinical CE is common. Whether the rate of infusion of intravenous fluids influences the occurrence or severity of CE is unknown.

This study demonstrates that the rate of fluid infusion in children with DKA does not substantially affect MRI measures of CE. Studies assessing measures other than edema formation are necessary to determine whether fluid infusion rates influence DKA-related brain injury. (Read the full article)

Endotracheal intubation of newborn infants is a common procedure. Competency in this skill is mandatory for many pediatric training programs. The safety and benefits of using a stylet for intubating newborn infants are unknown.

Pediatric trainees are commonly unsuccessful at performing endotracheal intubation. Adverse events of using a stylet are uncommon. The use of a stylet does not increase success rates. (Read the full article)

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

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

Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.

This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims. (Read the full article)

Socioeconomic status (SES) is inversely related to mortality and health in children; the higher an individual’s SES, the less likely illness and death. It is unknown whether the association of SES and pediatric mortality exists in the inpatient setting.

Within children’s hospitals, in-hospital mortality is inversely associated with SES, but is lower than expected for even the lowest SES quartile. The association between SES and mortality varies by clinical service line. (Read the full article)

The eating of non–nutrient dense snack foods is considered a major factor contributing to childhood obesity. Parents are often ineffective at encouraging healthier snacking habits.

Children consumed fewer calories when snacking on nutrient-rich cheese and vegetables compared with when they were served potato chips. (Read the full article)

When research involving children is determined to present greater than minimal risk but no potential for direct benefit, permission is required from both parents, unless one is not reasonably available. These requirements are variably understood and applied, and guidance is lacking.

In a study on newborn screening, a sizeable percentage of fathers were not reasonably available, reflecting complexities of parental status and family relations. Guidelines developed in this project may provide tools for researchers and institutions to apply in other contexts. (Read the full article)