Vaccinating youth is among the nation’s highest health care priorities. Despite proven health benefits, human papillomavirus vaccination rates remain low.

This is the first known study to test whether vaccination of high-risk adolescents is related to their or their parents’ previous knowledge levels. In the results presented, neither parental nor adolescent knowledge is related to subsequent adolescent vaccination. (Read the full article)

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important risk factor for neonatal jaundice in Nigeria. It is associated with severe hyperbilirubinemia among infants exposed to icterogenic agents. Elevated bilirubin levels have occasionally been demonstrated in G6PD-deficient infants without exposure to icterogenic agents.

Even without exposure to known icterogens, G6PD-deficient infants have a more rapid hematocrit decline and higher bilirubin levels than their G6PD-intermediate and G6PD-normal counterparts throughout the first week of life. (Read the full article)

In HIV-infected children, decisions to start antiretroviral therapy must weigh immunologic benefits against potential risks. Current guidelines recommend using CD4 percentage and age when deciding to start treatment. Population-level effects of these factors on immunologic recovery are unknown.

Starting antiretroviral therapy at higher CD4 percentages and younger ages maximizes potential for immunologic recovery. However, not all benefits are sustained, and viral failure may occur. Our results help clinicians better weigh immunologic benefits against viral failure risks. (Read the full article)

Various low-risk criteria have been developed to guide management of the febrile young infant (<90 days), but they differ in age criteria, recommendations, and implementation. Therefore, variation in care is likely but has not been previously studied.

There is wide variation in testing, treatment, and overall resource utilization in management of the febrile young infant across all 3 age groups: ≤28, 29 to 56, and 57 to 89 days. There may be opportunities to improve care variation without compromising outcomes. (Read the full article)

Children who have attention-deficit/hyperactivity disorder (ADHD) attending clinical services have poorer outcomes in adolescence on a range of measures. However, it is unknown how early in development these impairments appear, particularly for community-ascertained samples.

At age 6 to 8 years, children in the community with ADHD have significantly poorer mental health, academic performance and social function compared with control children. Children who have impairing ADHD symptoms should be referred early for assessment and intervention. (Read the full article)

The detection of critical congenital heart disease by fetal echocardiography or neonatal physical examination can have limitations. The addition of pulse oximetry screening in the newborn nursery increases the rate of diagnosis of these conditions before hospital discharge.

In a tertiary-care center with comprehensive fetal echocardiography, nearly all newborns with critical congenital heart disease are diagnosed prenatally. Pulse oximetry will identify more infants from settings with lower prenatal detection. Improving access to and training in fetal echocardiography should also improve detection of these conditions. (Read the full article)

In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs). Since 2004, hyperglycemic and diabetes risk with SGAs has been stated in product labels, and published guidelines have recommended baseline metabolic screening.

Between 2006 and 2011, 11% of children 2 to 18 years starting an SGA had baseline glucose assessed. Youth at risk for diabetes may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia. (Read the full article)

Neonatal circumcision in the United States has been estimated to be performed in ~58% of all neonates, and varies by US geographic region.

This study estimates neonatal and postneonatal circumcision rates among commercially insured males aged 0 to 18 years that were performed in both inpatient and outpatient settings. This study also estimates indications and payments for the procedure. (Read the full article)

Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group.

A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. (Read the full article)

The population of youth with chronic medical conditions is growing and many attend college. Yet we know little about US colleges’ capacity to identify and care for these youth, nor how transition guidelines and financing models should incorporate college health.

This is the first study to find that although many colleges can provide some clinical care for youth with chronic conditions, few colleges have systems to identify and track these students, elucidating gaps that pediatricians and institutions need to address. (Read the full article)

Neurodevelopment can be adversely affected by viral infections. Human herpesvirus-6 (HHV-6) is similar to cytomegalovirus and can cause central nervous system disease. Congenital HHV-6 infection occurs in ~1% of live births, with unknown neurodevelopmental consequences.

HHV-6 congenital infection is associated with lower scores on the Bayley Scales of Infant Development II Mental Development Index compared with control infants at 12 months of age and may have a detrimental effect on neurodevelopment. (Read the full article)

Studies have shown that reciprocal vocalizations between mother and infant have positive effects on language development. It has been shown that girls acquire vocabulary and language skills earlier than boys.

Mothers more readily respond to their infant’s vocal cues than fathers, and infants show a preferential vocal response to their mothers in the first months of life. Mothers respond preferentially to infant girls versus boys at birth and 44 weeks. (Read the full article)

In developed countries, child health disparities across wealth gradients are commonly widening; at the same time, child mortality in low- and middle-income countries is declining. Whether these declines are associated with widening or narrowing disparities is unknown.

A systematic analysis of the evidence on child mortality gradients by wealth in less-developed countries shows that mortality is declining fastest among the poorest in most countries, leading to declining disparities in this important indicator of child health. (Read the full article)

Case studies, abstracts, and small-sample research studies have shown that laundry detergent pods pose important poisoning risks to young children.

From 2012 through 2013, 17 230 children exposed to laundry detergent pods were reported to US poison control centers. Among children exposed, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome, including 1 confirmed death. (Read the full article)

National adolescent vaccination coverage estimates in 2013 among 13- to 17-year-olds are 86% for Tdap vaccine and 78% for MCV4. Comparatively, coverage with ≥3 doses of HPV vaccine is 38% among girls and 14% among boys.

One-fourth of 11-year-olds had HPV vaccine co-administered with Tdap vaccine, compared with two-thirds who had MCV4 co-administered. Whereas by age 17 years, >92% received Tdap vaccine and MCV4, only half of girls and one-fifth of boys completed HPV vaccination. (Read the full article)

Obesity among youth can have immediate health effects as well as longer-term consequences during adulthood. Overweight/obese children and adolescents are much more likely than normal-weight children to become overweight/obese adults.

This large, multisite longitudinal study examines patterns of exit from and entry into obesity between childhood and adolescence. Socioeconomic factors, body image, television habits, and parental obesity were important predictors of whether children remained obese or became obese. (Read the full article)

Children who suffer abusive head trauma (AHT) have lasting health and development problems. AHT can reduce life expectancy dramatically. AHT’s contribution to the burden of disease has been estimated only as part of a broad category of intentional injury.

The DALY burden of a severe AHT case averages 80% of the burden of death, with most survivors dying before age 21 years. Even mild AHT is extremely serious, with lasting sequelae that exceed the DALY burden of a severe burn. (Read the full article)

Younger age has been identified as an independent risk factor for all-terrain vehicle (ATV)-related injuries. Since the mid-1980s, one-third of ATV-related deaths have involved children younger than 18 years of age.

Using national data, we found both similarities and differences between pediatric age groups in the contribution of known risk factors to ATV-related deaths. The observed differences suggest the importance of targeting injury prevention approaches to specific age ranges. (Read the full article)

Germ cell tumors in children are heterogeneous and rare neoplasms that occur in various locations, such as gonads, the central nervous system, and the pelvis. The incidence rate has been increasing in some countries.

Population-based analyses of germ cell tumors in children are rare. This population-based study describes the incidence rates, trends, and survival of germ cell tumors in German children from 1987 to 2011. (Read the full article)

American Public Health Association reported >3.2 million students in the United States are bullied each year; 160 000 students skip school every day for fear of bullying. Little is known about whether bullying affects health-related quality of life (HRQOL) among college students.

Different types of bullying experiences affected different domains of HRQOL. Precollege bullying had long-term effects on HRQOL. Verbal/relational bullying-victimization experiences, mediated via depression, affected psychological HRQOL. Findings inform preventive and clinical practice to ameliorate the impact of bullying. (Read the full article)

Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine.

Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness. (Read the full article)

Head Start, a federally funded preschool program for low-income US children, has been reported to have beneficial effects on developmental outcomes. The association of Head Start participation with changes in children’s BMI has not been examined.

Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid). (Read the full article)

Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks’ gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated.

Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks’ gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. (Read the full article)

Uptake of rotavirus vaccines has increased steadily since introduction. Despite their demonstrated impact, rotavirus vaccine coverage is lower than for other vaccines recommended in infancy and disease continues to occur.

We observed higher rotavirus detection rates among patients from provider locations with lower rotavirus vaccine coverage; providers who do not offer rotavirus vaccine to age-eligible children may create pockets of susceptible children that serve as reservoirs of ongoing disease transmission. (Read the full article)

Both early and late introduction to gluten has been associated with increased risk for celiac disease (CD) and being breastfed at time of gluten introduction has been associated with a lower risk for CD.

In this prospective multinational study, time to first introduction to gluten-containing cereals is not an independent risk factor for developing CD, by a 5-year follow-up, neither on an overall level nor on country-level comparison. (Read the full article)

Parent refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in communities. Such clustering could pose public health risks and barriers to achieving quality benchmarks for immunization coverage.

We found that underimmunization and vaccine refusal cluster geographically. Spatial scan analysis may be a useful tool to identify locations where clinicians may face challenges to achieving benchmarks for immunization coverage and that deserve special focus for interventions. (Read the full article)

Asthma is heterogeneous and 40% to 70% of patients fail to achieve control with current treatment strategies. To delineate relevant subphenotypes of asthma, identify key factors, and test novel interventions, comprehensive repositories linking clinical, environmental, and biologic data are required.

This is the first statewide repository for inpatient pediatric asthma. The data collected will better define asthma phenotypes, identify care practices associated with the best health outcomes, and inform personalized care plans to reduce reutilization and readmission for pediatric asthma. (Read the full article)

Sleep apnea is a common condition in childhood, mainly managed by tonsillectomy. Codeine was recently contraindicated for pain management after surgery. Controversy exists regarding the safety and effectiveness of alternative medications, morphine, and ibuprofen.

Our findings suggest that ibuprofen does not increase tonsillar bleeding and in combination with acetaminophen is effective for pain management after tonsillectomy. Furthermore, standard morphine doses increased postoperative respiratory events and were not safe in all children. (Read the full article)

Immune-related bioactive proteins are highly concentrated in the colostrum of mothers who deliver preterm infants. Oropharyngeal administration was proposed as a safe and feasible alternative method of providing colostrum to immunocompromised premature infants.

Oropharyngeally administered colostrum during the first few days of life increased urinary secretory immunoglobulin A and lactoferrin, decreased urinary interleukin-1β, reduced salivary transforming growth factor-β1 and interleukin-8, and reduced the occurrence of clinical sepsis in extremely premature infants. (Read the full article)

Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse health outcomes in adolescence and into adulthood. In girls, externalizing behaviors are more strongly associated with earlier FSI than internalizing behaviors.

Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Internalizing behavior at ages 8 and 10 was associated with early FSI for boys but not girls. (Read the full article)

Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied.

Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits. (Read the full article)

In adults, adverse drug events account for 5% to 25% of all hospital admissions and 12% of emergency department (ED) visits of which 50% to 70% are preventable. There remains a significant gap in our understanding of the magnitude and impact of medication-related ED visits in pediatrics.

This study is the largest and most rigorous study performed evaluating the impact of medication-related visits to the ED in pediatrics and provides important information regarding the magnitude of this problem in our health care system. (Read the full article)

Moisture damage and mold increase the risk of asthma and asthmatic symptoms. However, the location of the damage, or the specific group of children who are at greater risk of asthma, is rarely taken into account.

Inspector-observed moisture damage or mold in the child’s bedroom, living room, or kitchen increased the risk of asthma and persistent asthma during a 6-year follow-up. Atopic children may be more susceptible to the effects of moisture damage and mold. (Read the full article)

Previous studies have demonstrated racial and ethnic differences in glycemic control even after adjustment for variables such as insulin dosage, diabetes duration, and socioeconomic status. It is controversial whether genetic, physiologic, cultural, socioeconomic, and/or provider-related factors underlie these disparities.

This study in a large, racially/ethnically diverse sample of children with type 1 diabetes demonstrates that racial disparities in insulin treatment methods and diabetes outcomes remain even after adjustment for socioeconomic status. (Read the full article)

Increasing data suggest that neonatal pain has long-term consequences. Pharmacologic interventions for minor pain are ineffective, and nonpharmacologic techniques (sucrose taste, pacifier suckling, breastfeeding) are effective and now widely used.

The taste of sucrose has been shown to be an effective and widely used analgesic for infants, and this study demonstrates that combining brief exposure to natural radiant warmth with the taste of sucrose improves the analgesic effect for the infant. (Read the full article)

Adequate sleep is critical for adolescent health. Available data suggest a historical downward trend in sleep behavior, but there has been no rigorous evaluation of recent US trends.

The proportion of adolescents who regularly obtain ≥7 hours of sleep is decreasing. Decreases in sleep exhibit period effects that are constant across adolescents according to gender, race, socioeconomic factors, and urbanicity. The gender gap in adequate sleep is widening. (Read the full article)

It is unclear whether developmental delays observed among infants with single-suture craniosynostosis (SSC) persist at school age. Few neurodevelopmental studies have examined children with SSC beyond age 3, with most having methodological limitations.

This study is the first to follow and test infants with SSC and a control group at school age. Infancy delays among children with SSC persisted at school age in some areas (IQ, math) but not others (reading, spelling). (Read the full article)

There is growing evidence reporting that moderately preterm, late preterm, and early term infants are at increased risk of developmental delay. The characteristics of this association are not well established in the literature.

In a sample of infants born between 32 and 41 weeks, there was an inverse and "dose response" relationship between gestational age and developmental delay risk using the ASQ at 8 and 18 months of corrected postnatal age. (Read the full article)

Early language delay is common in toddlers and is associated with poor academic outcomes, reading difficulties, and persistent communication problems. Despite these long-term sequelae, few interventions for toddlers with early language delays yield positive expressive and receptive language results.

A 28-session program delivered over 3 months can enhance parent language facilitation strategies. Unusually, the small short-term benefits were mainly in receptive, rather than expressive, language and vocabulary. Extended follow-up could determine the costs versus benefits of this promising approach. (Read the full article)

Childhood bacteremia caused by vaccine-preventable organisms has substantially declined over the last decade. Recognition of bacteremia in children is difficult, and delayed administration of antibiotics is associated with poor outcomes. Adults with health care–associated Gram-negative bacteremia experience delays in receiving appropriate antibiotics.

Bacteremia in children presenting to the emergency department is increasingly health care associated and resistant to empirical antibiotics. These infections are associated with increased length of stay. Rates of Gram-negative bacteremia have increased, and children with Gram-negative bacteremia experience delayed antibiotic administration. (Read the full article)

Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass and is associated with adverse outcomes. Renal biomarkers have been shown to predict postoperative AKI, but few studies have examined cardiac biomarkers for risk classification.

Preoperative levels of creatine kinase-MB and heart-type fatty acid binding protein are strongly associated with the development of postoperative AKI after pediatric cardiac surgery and can be used to improve preoperative clinical risk prediction. (Read the full article)

Although there is evidence regarding comorbidity of physical and mental disorders from clinical samples of specific disorders and treatment registries, there is limited evidence from systematic samples of youth with comprehensive information on the full range of mental and physical disorders.

This report is the first study to investigate the specificity of associations between a broad range of mental and physical conditions by using a large, systematically obtained pediatric sample with enriched information from electronic medical records and direct interviews. (Read the full article)

Firearm violence is a leading cause of death among US youth aged 14 to 24. The emergency department is a key setting for interacting with high-risk assault-injured youth and remains an underused but important setting for violence prevention programs.

High-risk youth seeking emergency department care for assault have high rates of firearm violence over the subsequent 2 years. Higher severity substance use, combined with negative retaliatory attitudes and access to firearms, increases this risk for involvement with firearm violence. (Read the full article)

Although the psychometric properties of the school-age Strengths and Difficulties Questionnaire (SDQ) have been extensively examined by using longitudinal data, the preschool version of the SDQ has only been explored in a limited number of cross-sectional studies.

This is the first psychometric study of the preschool SDQ using longitudinal data. We report measurement invariance over time, satisfactory reliability, construct and criterion validity, and predictive utility for subsequent behavioral problems (4 years) and clinical disorders (2 years). (Read the full article)

Smoking has been found to increase the risk of some specific congenital anomalies; however, results remain inconsistent. Nicotine replacement therapy (NRT) is increasingly being used as for smoking cessation in pregnancy although little is known about its association with congenital anomalies.

Being prescribed NRT while pregnant was not associated with major congenital anomalies (MCA), except a small increase in respiratory anomalies (3/1000 births). This must be considered in context of the rarity of MCAs and higher morbidities in the NRT group. (Read the full article)

Current childhood vaccination coverage rates among military dependents in the United States are not known. Past studies on childhood vaccination coverage in military dependents have shown mixed results, with the majority showing lower than ideal coverage rates.

This study analyzes a national database with 6 years of data and provider-confirmed vaccination status to describe the current documented vaccination coverage rates among military dependents in the United States. (Read the full article)

There is concern that the Bayley-III overestimates developmental functioning in preterm populations. The ability of the Bayley-III Cognitive and Language scales to predict later functioning in very preterm children has not been examined.

The norms on the Bayley-III Cognitive and Language scales at 24 months had low sensitivity for impairment across general cognitive, verbal and nonverbal reasoning domains at 4 years, which was better detected using cut-points based on local term-born reference data. (Read the full article)

Heart rate (HR) increases with increasing body temperature. Previous studies have characterized the relationship among HR, age, and temperature for patients in primary care and emergency department settings but not in hospitalized children.

Our data demonstrate an overall increase in HR by ~10 beats/minute for each 1°C increase in body temperature. Expected heart rates for hospitalized children differ from those for primary care and emergency department patients at the same age and temperature. (Read the full article)

Both obesity and developmental disabilities have increased in recent decades; however, the full long-term effects of prepregnancy obesity on a child’s psychosocial development remain unknown. Limited studies suggest associations between maternal prepregnancy obesity and child psychosocial development.

This study in 6-year-old children provides evidence that severe prepregnancy obesity is associated with adverse child psychosocial outcomes, including attention-deficit/hyperactivity disorder. These findings were not explained by many pregnancy and postpartum factors related to maternal obesity or child development. (Read the full article)

Clinical trials of the quadrivalent human papillomavirus vaccine show it to be highly efficacious in preventing vaccine-type–specific cervical dysplasia and anogenital warts, but few studies have assessed its effects in the real world and none have done so at the program/population level.

This study provides strong evidence of the early benefits of quadrivalent human papillomavirus vaccination on reductions in cervical dysplasia and possible reductions in anogenital warts among girls aged 14 to 17 years, offering additional justification for not delaying vaccination until girls are older. (Read the full article)