Approximately 27% of children with rotavirus in the hospital acquire it while hospitalized for another condition. Pediatric rotavirus vaccination greatly decreased the number of children hospitalized with rotavirus from 2007 to 2008.

Routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Thus, community-based vaccination efforts should be encouraged as a strategy to decrease hospital-acquired rotavirus. (Read the full article)

No studies have focused on the financial impact of fellowship training in pediatrics.

The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, the study may be valuable to policy makers who evaluate health care reform and pediatric workforce-allocation issues. (Read the full article)

Primary care providers (PCPs) identify patients with undescended testis (UDT) and refer them to surgical specialists. Referral beyond the recommended times for orchiopexy has been reported, and PCPs' accuracy in identifying and distinguishing UDTs from retractile testes has been questioned.

We describe 3 observations that are strongly correlated with UDT, that is, birth history of UDT, prematurity, and visible scrotal asymmetry. UDT diagnoses are best made by 8 months of age, to reduce confusion with testicular retraction and to facilitate timely orchiopexy. (Read the full article)

Although gastroenteritis guidelines describe the need to perform oral rehydration, it remains underused, resulting in excessive use of intravenous rehydration. Other interventions, such as antiemetic administration, vary according to location, often resulting in differences in cost and outcomes.

In this nationwide cohort, intravenous rehydration use varied dramatically. Use was associated with the institution providing care and an increase in the need for future health care provider visits. Use of ondansetron also varied significantly across Canada. (Read the full article)

The direct effects of prolactin on the nutritional and antimicrobial composition of breast milk have not been examined previously in women.

The study demonstrates that recombinant human prolactin increases milk volume, induces changes in milk composition consistent with those during normal lactogenesis, and increases antimicrobially active oligosaccharide concentrations. The data suggest that prolactin is an important mediator of normal lactogenesis. (Read the full article)

For treatment of obesity in preadolescent children, approaches that focus on parents taking sole responsibility for implementing weight-management strategies may be most effective. However, the optimal content, intensity, and duration of programs for obese children remain unclear.

Targeting parents only, a 10% relative weight loss is achievable in moderately obese preadolescent children and can be maintained 2 years from baseline, which justifies an investment in treatment as a secondary obesity-prevention strategy. (Read the full article)

For mothers of children with chronic medical conditions or disabilities, such as epilepsy or cerebral palsy, a history of maternal unresolved grief regarding the child's diagnosis has been associated with insecure infant-mother attachment.

Unresolved grief related to a preterm birth is associated with the development of insecure infantmother attachment. Mothers with resolved grief after preterm birth are 2.9 times as likely to have securely attached infants, compared with mothers with unresolved grief. (Read the full article)

The efficacy of intravenous immunoglobulin and corticosteroid pulse combination therapy for refractory Kawasaki disease has been established. The Egami score can be used to predict which patients are likely to have refractory Kawasaki disease.

As a new strategy for primary treatment, intravenous immunoglobulin and corticosteroid pulse combination therapy is safe and effective for patients predicted to have refractory Kawasaki disease based on the Egami score. (Read the full article)

Educators, public health authorities, and law enforcement are confronting an increasing number of cases in which youth made sexual images of themselves and other minors and transmitted them via cell phones and the Internet.

This study provides the first detailed and comprehensive national estimate of the percentage of youth who create and distribute various kinds of sexual images. (Read the full article)

Over 500 000 children in the United States sustain a traumatic brain injury (TBI) each year. Headaches are commonly reported after TBI in adults, but little is known about the epidemiology of headache after pediatric TBI.

Headaches are more common 3 months after pediatric TBI than after arm injury. The frequency of headache after TBI is related to patient gender, age, and injury severity. Headaches after mild TBI were most common among girls and teenagers. (Read the full article)

A delay in seeking medical care for children with significant injury often raises a concern about child abuse, but there are few data describing the range of responses children display after accidental fracture for providers to use in comparison.

This study presents the range of responses exhibited by children after accidental fractures and identifies factors associated with a delay in seeking medical care. No child was asymptomatic, although a minority did not manifest all expected responses after their injury. (Read the full article)

Gallbladder disease in children is an evolving entity and studies suggest an increasing frequency of symptomatic pediatric gallbladder disease and resultant cholecystectomies.

Hispanic ethnicity and obesity are epidemiologically significant risk factors for symptomatic gallbladder disease in the pediatric population. (Read the full article)

Conduct problems, substance use, substance use problems, and depressive symptoms increase as black adolescents enter high school. Although family-centered prevention programs deter these problems during middle school, no such programs have been developed and evaluated for black high school students.

This study demonstrates that participation in a family-centered preventive intervention reduces conduct problems, substance use, and substance use problems among black adolescents by more than 30% compared with adolescents in an attention control condition across nearly 2 years. (Read the full article)

Children with sickle cell disease are at high risk of complications from influenza infection and have been recommended to receive annual influenza vaccine since the 1970s. Few safety studies, however, have examined the safety of influenza vaccine in this population.

This large cohort study did not find an association between influenza vaccination and hospitalization for sickle cell crises in children with sickle cell anemia. (Read the full article)

Predischarge serum or transcutaneous bilirubinometry (TcB) measurements are recommended as appropriate screening options for identifying infants at risk for neonatal hyperbilirubinemia (NH). Visual inspection for jaundice is not reliable at identifying infants with NH in the community.

When compared with visual inspection alone, coordinated TcB screening for NH in acute-care and community settings is associated with significant improvements in laboratory utilization, patient care, convenience, and safety. (Read the full article)

Lactoferrin is a glycoprotein with anti-infective activities being part of the innate defensive network. Bovine and human lactoferrin share high homology. Bovine lactoferrin can prevent late-onset sepsis in preterm very low birth weight neonates.

In preterm very low birth weight infants, bovine lactoferrin is able to prevent not only late-onset sepsis but also systemic fungal infections. This protection is achieved independently from their colonization status. (Read the full article)

Palivizumab administration to well-defined, high-risk groups results in reductions of hospital days, but the intervention is costly. The American Academy of Pediatrics has recommended which groups should be administered palivizumab for the best clinical and cost-effective outcomes.

In a primary practice, palivizumab was frequently used for children outside the recommended groups. Through close oversight and education, the use of palivizumab outside of recommendations was decreased. Palivizumab primary practice usage issues such as proper numbers of doses and timely administration need improvement. (Read the full article)

Extreme preterm birth is associated with developmental shortcomings that may reduce exercise capacity and participation in physical activities in later life. The number of studies addressing these issues in adolescent populations is limited, test methods differ, and results are diverging.

Exercise capacity after preterm birth was in the same range as in term-born control subjects. Participation in physical activity was lower in preterm subjects compared with control subjects; however, the response to exercise in terms of increased aerobic capacity was similar. (Read the full article)

Three-fourths of US preschool-age children are in child care; many are not achieving recommended levels of physical activity. Daily physical activity is essential for motor and socioemotional development and for the prevention of obesity. Little is known about physical-activity barriers in child care.

Injury and school-readiness concerns may inhibit children’s physical activity in child care. Fixed playground equipment that meets licensing codes is unchallenging and uninteresting to children. Centers may cut time and space for gross motor play to address concerns about school readiness. (Read the full article)

Upper respiratory tract infections (URIs) are very common in children. Currently, there are no effective preventive measures for URI. There are no studies on the effect of montelukast for prevention of URI.

In a randomized, double-blind, placebo-controlled study of preschool-aged children, 12-week prophylactic treatment with montelukast did not reduce the incidence of URI. (Read the full article)

Studies on vaccine safety are crucial to the ongoing success of our national immunization program. ITP has a known association with MMR in young children, occurring in 1 in 40 000 doses. The risk after other childhood vaccines is unknown.

This study found no increased risk of ITP after vaccines other than MMR in young children, confirmed an association of ITP with MMR, and also found that ITP may occur after certain other vaccines in older children. (Read the full article)

Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking.

Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time. (Read the full article)

Macroglossia is a clinical feature of several disorders and a common reason for additional diagnostic investigations during infancy. Limited research has been done on the evaluation of macroglossia when other features are not suggestive of Beckwith-Wiedemann syndrome.

All patients with apparently isolated macroglossia should have at least initial evaluation with abdominal ultrasounds and molecular studies for Beckwith-Wiedemann syndrome before a final diagnosis is given. Other common diagnoses included isolated macroglossia, chromosomal abnormalities, hypothyroidism, and mucopolysaccharidoses. (Read the full article)

Over the past decade, drug oversight committees and professional organizations have debated the evidence regarding cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deficit/hyperactivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this controversy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deficit/hyperactivity disorder before prescribing stimulants. (Read the full article)

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspecific clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been associated with pseudo-outbreaks.

Contamination of specimens with vaccine derived Bordetella pertussis DNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modifiable factors. (Read the full article)

Registries have been established in a number of countries to monitor the health of patients with cystic fibrosis. Few international comparisons have been made between registries. International data registry comparisons may be useful for informing best practice and benchmarking.

Registry comparisons are feasible but are limited by factors such as nonstandardization of data collection. Lung function was lower in Australian children with cystic fibrosis compared with their US counterparts after adjusting for the benefits of diagnosis after newborn screening. (Read the full article)

Traumatic brain injury in school-aged children is associated with intellectual, behavioral, and social deficits. Research into outcomes of children injured before 3 years of age is limited despite data suggesting a high incidence of injury in this age group.

Results show that a moderate to severe traumatic brain injury before 3 years of age is associated with lowered cognitive function. Furthermore, this study highlights the link between social disadvantage and poor outcomes after traumatic brain injury in early childhood. (Read the full article)

Hepatitis A infection causes severe disease among adolescents and adults. Hepatitis A vaccination (HepA) is recommended universally at 1 year, with vaccination through 18 years based on risk or desire for protection.

This is the first study to evaluate adolescent HepA coverage in the United States using provider-reported vaccination data. HepA coverage was low among adolescents, leaving a large population susceptible to hepatitis A infection maturing into adulthood. (Read the full article)

The standard initial management for infants and children with acute pyelonephritis is intravenous antibiotic treatment.

Our results support the use of an oral cefixime treatment of initial episodes of acute pyelonephritis involving a gram-negative bacteria strain in children aged 1 month to 3 years who are without urological abnormalities and without clinical hemodynamic impairment. (Read the full article)

Although it has been shown that cystic fibrosis newborn screening is beneficial, the strategies vary widely, and there has been uncertainty about the costs and consequences of different algorithms and whether screening methods/decisions should be based on assumed cost differences.

This study contributes by offering a comparison of both costs, assessed comprehensively, and the consequences associated with the 2 most popular screening methodologies, immunoreactive trypsinogen/immunoreactive trypsinogen and immunoreactive trypsinogen/DNA, by using a decision-tree framework allowing variation in the model parameters. (Read the full article)

The social and emotional burdens of ostracism are well known, but few studies have tested whether ostracism adversely alters physical activity behaviors that may result in maintenance of childhood obesity.

This is the first study to experimentally assess the effect of simulated ostracism, or social exclusion, on physical activity behavior in children. Ostracism reduced accelerometer counts by 22% and increased time allocated to sedentary behaviors by 41%. (Read the full article)

Prior to the Affordable Care Act of 2010, 34 states enacted laws extending eligibility for parents’ health insurance to adult children. Few studies have examined their impact; a single study found no change in insurance 1 year after enactment.

States that expanded parents’ insurance eligibility to young adults were associated with higher rates of insurance coverage, identification of a personal clinician, physical exams, and lower forgone care due to cost. The Affordable Care Act may similarly improve access to care. (Read the full article)

Although China has the largest birth population in the world and a number of multicenter studies of neonatal respiratory failure are reported, there is a paucity of data regarding outcome measurement of very premature neonates requiring respiratory care and surfactant therapy.

This study is the largest survey, to date, in a Chinese network of 55 NICUs that presents the incidence, morbidity, and mortality rates, with risk factors of neonatal respiratory failure, with special emphasis on surfactant-treated very immature infants. (Read the full article)

Community-acquired pneumonia (CAP) is a common pediatric illness caused by Streptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.

This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Furthermore, change in therapy did not lead to increased adverse outcomes. (Read the full article)

Parent-infant bed-sharing is a common behavior of breastfeeding mothers and various ethnic groups. Under certain circumstances, it is associated with an increased risk of sudden infant death. Blanket prohibitions against bed-sharing conflict with breastfeeding promotion and inhibit safe bed-sharing discussion.

Bed-sharing and sofa-sharing were almost mutually exclusive. Pakistani families avoided sofa-sharing and hazardous bed-sharing, and have a very low rate of sudden infant death syndrome. White British families were more likely to smoke, drink alcohol, and sofa-share with their infants. (Read the full article)

Infantile colic affects almost 10% of all infants and is characterized by crying and fussing in an otherwise healthy and well-fed infant. Prenatal exposure to tobacco smoking is a risk factor, but it is unclear whether nicotine causes the association.

Infants exposed to nicotine replacement therapy during pregnancy had elevated infantile colic risk of the same magnitude as infants exposed to tobacco smoking. Intrauterine exposure to nicotine may play a causal role in the pathogenesis of infantile colic. (Read the full article)

Approximately 1.1% to 5.9% of febrile infants aged <90 days have bacteremia, but the incidence of bacteremia in this age is unknown. Escherichia coli, group B Streptococcus, and Staphylococcus aureus are the leading causes of bacteremia.

Bacteremia occurs in 2.2% of infants who have a blood culture drawn. The incidence rate of true bacteremia was 0.57 in 1000 full-term births. The most common pathogens were Escherichia coli (56%), group B Streptococcus (21%), and Staphylococcus aureus (8%). (Read the full article)

Rare diseases in childhood can be debilitating and require lifelong care. Since 1983, the Orphan Drug Act incentives have stimulated the development and significantly improved the availability of treatment products for patients with rare diseases.

We report an increasing pediatric orphan product designations and approvals from 2000 to 2009. The trend indicates that the Orphan Drug Act has continued to address this important unmet need. (Read the full article)

Active video games can enable children under laboratory conditions to participate in moderate, and even vigorous, physical activity. There are inconsistencies in the literature, however, about whether active video games enable children to increase physical activity under more naturalistic circumstances.

This study tests whether children receiving a new active video game spontaneously engaged in more physical activity, and whether commercially available active video games have a public health benefit. No additional physical activity was detected, suggesting no public health benefit. (Read the full article)

There is a perception among clinicians that methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and/or meningitis result in a greater burden of disease than invasive infections attributed to methicillin-susceptible Staphylococcus aureus (MSSA) among very low birth weight (VLBW) infants.

VLBW infants with MRSA and MSSA bacteremia and/or meningitis have equivalent morbidity and mortality. These findings suggest that allocation of resources for prevention and treatment of both MRSA and MSSA infections among VLBW infants should be comparable. (Read the full article)

In the prerotavirus vaccine era, diarrhea-associated hospitalization and outpatient rates among American Indian and Alaska Native children were higher than those among the general US population. Routine rotavirus vaccination has dramatically decreased rotavirus diarrhea burden in the general US population.

Decreases in diarrhea-associated hospitalization and outpatient rates among American Indian and Alaska Native children in postvaccine years were observed in all Indian Health Service regions, with declines greater in each subsequent year after vaccine introduction. (Read the full article)

Healthcare Effectiveness Data and Information Set (HEDIS) measures are widely used to assess the reliability of pediatric immunization delivery. The extent to which these measures provide accurate ("is this child up-to-date on immunizations?") and useful ("is this child due for catch-up immunizations?") information is unclear.

Overall, HEDIS childhood immunization measures are accurate and useful. Users of HEDIS data should be aware, however, that certain immunizations (eg, hepatitis B, pneumococcal conjugate) and children (eg, those with a single overdue immunization) are more prone to HEDIS misclassification. (Read the full article)

Prone sleep, bed-sharing, maternal smoking during pregnancy, and prematurity increase the risk of sudden infant death syndrome. The sudden infant death syndrome rate initially declined dramatically after the initiation of the US Back-to-Sleep campaign in 1994, but subsequently plateaued.

The risk profile has changed since the Back-to-Sleep campaign; the prevalence of simultaneous risks has remained consistent. Intrinsic and extrinsic risks provide unification into 1 underlying triple-risk model and insights into potential underlying mechanisms. (Read the full article)

Emergency contraception is a safe and effective method of pregnancy prevention after unprotected intercourse.

Pharmacies commonly communicate misinformation, both to adolescents and to physicians, concerning who is able to access emergency contraception and through what means. (Read the full article)

Febrile seizure risk 7 to 10 days after measles-mumps-rubella-varicella (MMRV) is double that of separate measles-mumps-rubella (MMR) and varicella vaccines among 1-year-olds. Whether MMRV or MMR and varicella affect febrile seizure risk among 4- to 6-year-olds has not been reported.

Using Vaccine Safety Datalink data, we examined risk for febrile seizures after measles-containing vaccines. This study provides reassurance that MMRV and separately administered MMR and varicella were not associated with increased risk of febrile seizures among 4- to 6-year-olds. (Read the full article)

The presence of malodorous urine is often mentioned as one of the clinical manifestations of urinary tract infection (UTI) in young children, yet the few studies looking at this symptom are contradictory.

Our study demonstrates that malodorous urine as reported by parents increases the likelihood of UTI among young children evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI. (Read the full article)

Autism is widely considered a heterogeneous disorder in terms of etiology and phenotype. Although autism is usually a lifelong disorder, little is known about the rate or timing of how children develop regarding their communication and social functioning.

Utilizing annual evaluations for a large population of children with autism, we describe the 6 most common trajectories from diagnosis through age 14 years. Trajectories revealed considerable variation, and high socioeconomic status children were more likely to experience rapid improvement. (Read the full article)

Some but not all randomized trials have shown effects of probiotics on incidence and duration of diarrhea and respiratory tract infections among children in developing countries. Calcium improves resistance to intestinal infections in adults, but efficacy in children is unknown.

Lactobacillus reuteri DSM17938 may prevent diarrhea, especially in children with lower nutritional status. Regular calcium milk, alone or with Lactobacillus casei CRL431, did not reduce diarrhea. None of the interventions affected respiratory tract infections in these Indonesian children. (Read the full article)

Although all residents progressively assume responsibility for clinical skills under the teaching and supervision of attending physicians, senior residents also assume responsibility for teaching and supervising. This leads to a dynamic negotiation of responsibilities, particularly on clinical work rounds.

A better understanding of how attending physicians and senior residents negotiate shared responsibilities for teaching and supervising, and the context in which this negotiation occurs, may clarify assumptions and set expectations for resident training. (Read the full article)

Rural Alaska children have high rates of hospitalization with lower respiratory tract infections from a variety of pathogens. Past studies of risk factors for respiratory syncytial virus infection associated medically high-risk status, household crowding, and infant feeding practices with hospitalization.

This study reveals the importance of medically high-risk status and infant feeding practices as important factors in respiratory hospitalization. In addition, we identified woodstove use and the absence of 2 or more sinks in household as risk factors for hospitalization. (Read the full article)