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)

Previous research on potential deleterious effects of typically developing children growing up in households with children with disability has produced mixed results. Research methods have been cited as a problem in many studies.

This is the largest known empirical study comparing functional impairment in siblings living with a child with disability and siblings residing with children who are typically developing. This study also follows the trajectory of functional impairment across 2 measurement periods. (Read the full article)

Sugar-sweetened beverage (SSB) consumption in school-age children and adolescents is linked to heavier weight, and decreased SSB consumption results in less weight gain. Reports regarding these associations among children aged 2 to 5 years have been mixed.

Preschool-aged and kindergarten children drinking SSB compared with infrequent/nondrinkers had higher BMI z scores. SSB consumption is also associated with higher weight status among children aged 2 to 5 years. (Read the full article)

Adolescents are likely to smoke if their parent(s) smoke. Little research uses prospective longitudinal data from parents and children to more confidently document these intergenerational associations, alongside potential confounders (parental education) and mediators (school achievement, mental health, older sibling smoking).

Analyses of long-term multigenerational data show how diverse parental smoking trajectories influence child smoking, controlling for measured confounders. The risk of smoking is especially high among children residing with a persistent heavy smoking parent and an older sibling who smokes. (Read the full article)

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

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

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)

The number of overweight and obese children has dramatically increased in recent decades. To combat this trend, information on possible gender-related differences in risk factors of overweight and obesity is critical.

This study examines associations of gender and physiologic and behavior measurements with potential cardiovascular risk. Lunch consumption and screen time were associated with weight; however, other associations with weight differ by gender. This information can be used to tailor future interventions. (Read the full article)

At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood.

This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. (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)

Bisphenol A (BPA) is a known endocrine disruptor found in many products with which children come into contact. Although BPA in adults is associated with obesity, diabetes, and cardiovascular disease, little is known about its effects in children.

This study found that higher BPA levels are associated with obesity and abnormal waist circumference–to–height ratio in children. (Read the full article)

Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates.

This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. (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)

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)

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

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

The Faces Pain Scale–Revised and Color Analog Scale are self-report pain scales that are commonly used for children in the clinical and research settings.

The Faces Pain Scale–Revised and Color Analog Scale overall demonstrate strong psychometric properties in children 4 to 17 years of age, including within subgroups of age, sex, and ethnicity. Convergent validity, however, is questionable in children <7 years old. (Read the full article)

Persons with sickle cell anemia are known to have increased medical expenses, but little is known about the effects of hydroxyurea treatment on costs. In adults with severe sickle cell anemia, hydroxyurea has been reported to reduce expenses from hospitalization.

In this randomized placebo-controlled prospective multicenter trial of hydroxyurea in very young children with sickle cell anemia, not selected for severity, hydroxyurea was associated with significant medical cost savings due to a reduction in hospitalization expenses. (Read the full article)

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

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

Hypovitaminosis D is common among children. Although there is prolific biochemical literature linking vitamin D to enteric immunologic function, there is a paucity of prospective data exploring the role of supplementation in prevention of diarrheal illnesses.

In a high-risk population, quarterly supplementation with 100 000 IU of vitamin D₃ did not reduce the risk for first or recurrent diarrheal illnesses in a population of children aged 1 to 29 months in a low-income inner city setting. (Read the full article)

Health insurance is associated with improved health for children, but gay and lesbian parents face barriers to adding their children to private health insurance. Little is known about the extent to which insurance disparities exist for children with same-sex parents.

Children with same-sex parents are less likely to have private health insurance. When children live in states in which legal same-sex marriage, civil unions, domestic partnerships, or second-parent adoptions are available, disparities in private insurance diminish for children with same-sex parents. (Read the full article)

Some infants presenting with bronchiolitis are later diagnosed with asthma. Corticosteroid treatment of all infants with bronchiolitis is not clearly efficacious.

We used infant eczema or asthma history in a first-degree relative to select patients with bronchiolitis for dexamethasone or placebo blinded treatment. Dexamethasone treatment of 5 days led to significantly earlier readiness for discharge from infirmary treatment. (Read the full article)

Unintentional injuries lead to a significant number of children suffering from long-lasting posttraumatic stress symptoms. Therefore, early identification of individuals at risk is crucial to provide preventative interventions. However, currently, no early screener has been evaluated in preschool-aged children.

Good sensitivity (85%) and acceptable specificity (63%) were found for an early screening measure for preschool-aged children after accidental injury. Hence, the 21-item Pediatric Emotional Distress Scale–Early Screener, a reliable and valid early screening instrument, is suggested for use within a stepped-care model. (Read the full article)

Invasive methicillin-resistant Staphylococcus aureus (MRSA) in children is associated with high morbidity and mortality. Although reductions in health care–associated MRSA infection among adults are documented, it is unclear if a similar trend is occurring among children.

Data from population-based surveillance were analyzed to assess changes in invasive MRSA infection incidence over time. This analysis describes the epidemiology and trends of invasive MRSA infections among children in 9 US metropolitan areas and estimates national burden. (Read the full article)

Over the past decade, child welfare has focused on permanency for children through policy changes intended to reduce OOH placements. Yet little is known about recent trends in child maltreatment or children in OOH care.

Despite increased maltreatment investigations from 2000 through 2010, the population of children in OOH placements declined, while experiencing greater prior trauma and current emotional disturbance. These changes may have resulted in a smaller but more complex OOH population. (Read the full article)

Cross-sectional estimates suggest that one-third of children are enrolled in Medicaid or other public insurance programs. The percentage of children enrolled in Medicaid at any point during childhood, and which children use Medicaid as a longer-term insurance source, is unknown.

Over a 5-year period, 41% of children were enrolled in Medicaid at some point. Of those children, 51.5% were enrolled during all 5 years. Children with sociodemographic risk factors are more often enrolled for longer periods of childhood. (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)

Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use.

In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children, and those lacking private health insurance was documented. (Read the full article)

Prosmoking messages, delivered through marketing and the media, can reach very young children and influence attitudes and behaviors around smoking.

Marketing of tobacco and cigarette brands has successfully reached young children in low- and middle-income countries. More effective measures are needed to restrict the reach of tobacco marketing. (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)

Apnea is a life-threatening complication of bronchiolitis and has been associated with younger age, prematurity, and a parental report of apnea. Apnea is classically attributed to the respiratory syncytial virus, but little is known about the role of other viruses.

Among hospitalized children, low or high respiratory rates or low oxygen saturation on presentation were associated with subsequent apnea in the hospital. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens. (Read the full article)

Research has focused on primarily white parents, months to years after their infant/child or adult child died of cancer, accidental injury, sudden infant death syndrome, or suicide. Many parents experience depression and/or posttraumatic stress disorder and greater risk for some physical health problems.

Data on hospitalizations, changes in and management of chronic conditions, complexity of medication regimens, depression, and posttraumatic stress disorder were collected over 13 months from 249 Hispanic, black, and white parents in 188 families who experienced an infant/child NICU/PICU death. (Read the full article)

Pneumonia is the leading cause of death in young children worldwide. Anemia, widely prevalent globally, is not routinely assessed when treating pneumonia. The effect of anemia and high altitude on outcome of pneumonia is not well described.

Anemia at high altitude increases the risk of poor outcome with severe pneumonia. Children with severe pneumonia at high altitude present with more severe hypoxemia and have a longer time to recovery than children at low altitude. (Read the full article)

Prenatal exposures to diverse pollutants and psychosocial stressors have been shown independently to adversely affect child development. Less is known about the potential interactions between these factors, although they commonly co-occur, especially in disadvantaged populations.

The combination of high prenatal exposure to environmental polycyclic aromatic hydrocarbons and maternal demoralization adversely affects child behavior, and maternal demoralization has a greater effect among children with high prenatal polycyclic aromatic hydrocarbon exposure for a majority of behavioral symptoms. (Read the full article)

Links between clinically diagnosed sleep problems and adverse behavioral outcomes are well documented. However, in nonclinical populations, causal links between disrupted sleep and the development of behavioral difficulties are far from clear.

Seven-year-old children with nonregular bedtimes had more behavioral difficulties than children who had regular bedtimes. There were clear dose–response relationships, and the effects of not having regular bedtimes appeared to be reversible. (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)

In January 2006, a public health advisory and boxed warning for long-term safety and the risk of malignancies and a medication guide were issued for topical calcineurin inhibitors, tacrolimus and pimecrolimus.

Evaluation of off-label use of topical calcineurin inhibitors in children before and after regulatory action by the Food and Drug Administration is important to understand the impact of regulatory action. (Read the full article)

Gunshot injuries are an important cause of preventable injury and mortality in children, with emergency services often providing the initial care for patients. However, there is little recent population-based research to guide public health, injury prevention, and health policy efforts.

Gunshot injuries are uncommon in children, but cause greater injury severity, need for major surgery, mortality, and costs compared with other injury mechanisms. There is also large variation in the population-adjusted incidence of pediatric gunshot injuries between regions. (Read the full article)

Physical activity (PA) levels in preschool children vary considerably between preschools, and are positively associated with the overall quality of the preschool. However, knowledge regarding specific characteristics of the preschool environment hypothesized to promote PA is inconsistent and lacking.

This study tested multiple potential correlates of preschool children’s objectively measured moderate and vigorous PA level during preschool attendance, identifying size of indoor area per child and location of preschool building on the playground as new potentially modifiable correlates. (Read the full article)

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

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

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)

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)

School outbreak investigation in Quebec, Canada suggested that adolescents previously vaccinated with 2 doses of measles vaccine beginning at 12 months of age were at greater measles risk than those whose first dose was given at ≥15 months of age.

Greater measles risk among earlier first-of-2-dose vaccine recipients was replicated as a generalized provincial finding during the 2011 epidemic in Quebec, Canada. The mechanism remains unknown, but the findings warrant additional evaluation in the context of measles elimination efforts. (Read the full article)

The etiology of childhood cancers is largely unknown. However, excessive fetal growth has been associated with some childhood cancers. One of the most consistent findings is that high birth weight is associated with an increased risk of childhood leukemia.

Examining large, population-based birth and cancer registry data from 4 Nordic countries, high birth weight was the most strongly associated with risk of many childhood cancers among several measures of fetal growth that have not previously been extensively assessed. (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)

It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child’s risk for specific adverse health outcomes.

By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors. (Read the full article)

Epidemiologic studies have documented that children’s sleep duration is associated with obesity risk. Experimental studies with adults suggest that short sleep may lead to changes in appetite-regulating hormones and food intake, which could lead to weight gain over time.

This controlled experimental study demonstrates that compared to sleeping less, when children increase sleep, they report decreased caloric intake, have lower fasting leptin levels, and weigh less. Such changes, if maintained, could help prevent excess weight gain over time. (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)

Children with chronic illnesses tend to be sicker during infections than previously healthy children but are triaged in the same way, even though the validity of triage systems has not yet been evaluated in these chronically sick children.

The performance of the Manchester Triage System was lower for children with a chronic illness than for previously healthy children. Children with cardiovascular illnesses, respiratory illnesses, gastrointestinal illnesses, or other congenital or genetic defects were especially at risk of being undertriaged. (Read the full article)

The World Health Organization estimates that ~700 million children breathe tobacco smoke polluted air, particularly at home. Educational strategies either directly or indirectly targeting household decision-makers through other family members are effective in reducing children's exposure in private homes.

Intensive intervention was effective in decreasing children’s personal exposure to secondhand smoke (SHS), educating mothers about SHS, and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s personal exposure to SHS was not statistically significant. (Read the full article)