Some studies demonstrate that adolescents have different perinatal risks and outcomes than nonadolescents. Few studies have explored the maternity experiences or practices of adolescents that may underlie these differences, or compared these with nonadolescents by using a nationally representative sample.

Adolescents and young adults were more likely to experience physical abuse, late prenatal care initiation, poor prenatal health behaviors, lower breastfeeding initiation and duration rates, postpartum depression, and lower folic acid supplementation than adult women. (Read the full article)

Omega-3 fatty acids (O3FA) are commonly used as complementary treatments in pediatric psychiatric disorders, including Tourette’s disorder (TD), and are well known to have anti-inflammatory properties. However, no studies to date have examined the effects of O3FA on pediatric TD.

This is the first double-blind, placebo-controlled clinical trial of O3FA in pediatric TD. The results indicate that O3FA supplementation may be beneficial in the reduction of tic-related impairment for some children and adolescents with TD, but not tics per se. (Read the full article)

Despite recommendations and a universal immunization program, a recent survey reported suboptimal influenza vaccination coverage in children aged 6 to 23 months in Ontario. Little is known about predictors of coverage in young children to target immunization strategies.

Full influenza vaccination coverage in young children in Ontario is <10% and declining since the 2006–2007 season. Medically high-risk children including low birth weight infants are more likely to be immunized, but maternal and health services characteristics remain important. (Read the full article)

Although soy protein–based infant formula is known to support physical growth equal to that of infants fed cow's milk–based formula, data are lacking on developmental status of infants fed soy formula compared with breast milk or milk formula.

Infants fed soy protein–based formula scored within normal limits on standardized developmental testing and did not differ from infants fed cow’s milk–based formula. Breastfed infants have a slight advantage on cognitive development compared with formula-fed infants. (Read the full article)

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Our findings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to improve morbidity-free survival. (Read the full article)

In 2011, the Accreditation Council on Graduate Medical Education increased restrictions on resident duty-hours. Further changes have been considered, including greater work-hour restrictions and lengthening residency. Residents’ views about these policies are unclear.

This is the first systematic, national inquiry into resident opinions on reduced work-hours and longer residency. More pediatric residents support than oppose reduced hours, and a minority would add a year to residency to achieve them. (Read the full article)

Early speech and language delays are risk factors for later developmental and social difficulties. It is easier to identify them retrospectively than prospectively. Population characteristics and prevalence rates make screening problematic.

Using data from a birth cohort, this study identifies predictors of language performance at 5 years and 4 patterns of change between 3 and 5 years, comparing those who change with those whose profile remains low across time points. (Read the full article)

Chronic fatigue syndrome (CFS) is a disabling illness. Some children with chronic disabling fatigue are housebound. Some primary care physicians find making the diagnosis of CFS difficult.

Chronic disabling fatigue is more common in 13-year-olds than previously realized with a population prevalence of ~2.0%. Chronic disabling fatigue in teenagers is more common in those with higher levels of early family adversity. (Read the full article)

Various studies have documented marked racial/ethnic disparities in children’s receipt of dental services at single time points or brief periods.

This study reveals significant improvements in children’s receipt of dental care overall, as well as a dramatic narrowing of African American/white disparities in children’s receipt of dental services over the last 40 years in the United States. (Read the full article)

Childhood abuse has been associated with obesity risk in adulthood. Little is known regarding the impact of abuse severity on risk, potential mechanisms are poorly understood, and few studies have been conducted among minority populations.

Severity of child/teenager physical and sexual abuse is associated with increased risk for adult obesity and/or central adiposity in adulthood. These are the first such findings in a large cohort of US black women. (Read the full article)

This research presents the first 2 experimental studies on the short-term effects of smoking portrayal in movies on children’s beliefs about smoking.

Exposure to movie smoking from cartoon and family-oriented movies had no effect on implicit associations toward smoking. For smoking beliefs, effects were again small and only statistically significant for social norms regarding smoking. (Read the full article)

Adolescent dating violence has been studied from the perpetrators' and survivors' perspectives. The risk and protective factors have been explored, and the strength of the association of these factors with adolescent dating violence has been adequately described.

This study assessed the perceptions and practices of school counselors on adolescent dating violence. Knowing school personnel’s practices and perceptions may help researchers and practitioners gain insights into possible ways to alleviate the problem of dating violence in adolescents. (Read the full article)

Trisomy 13 and 18 are conditions with 1-year survival rates of less than 10% and have traditionally been treated with palliative care. There are increasing reports of ethical dilemmas caused by parental requests for clinical interventions.

Parents who belong to social networks report an enriching family experience and describe surviving children as happy. Many of these parents describe challenging encounters with health care providers. (Read the full article)

Infantile hemangiomas have a period of rapid growth in early infancy. Most hemangioma growth is completed by 5 months of age, but the majority of patients are not seen by a specialist until after the growth phase is complete.

The most rapid hemangioma growth is between 1 and 2 months of life, much earlier than previously believed. Patients with high-risk hemangiomas should be followed closely, and treatment initiation should be considered before or during the most rapid growth phase. (Read the full article)

Asthma is a major reason for pediatric hospital admission. The Joint Commission requires freestanding children’s hospitals to report compliance with 3 Children’s Asthma Care quality measures. High compliance with these measures should result in decreased admissions and emergency department visits.

Implementation of a standardized care process model for hospitalized asthmatic children resulted in high compliance with all 3 measures. Measures 1 and 2 did not provide an opportunity for improvement. Compliance with measure 3 resulted in significant decreases in readmission. (Read the full article)

Approximately 80% of all preterm children are born moderately preterm (32–36 weeks’ gestation). Moderately preterm children are at increased risk for developmental delays, but the specific neuropsychological functions that may underlie these delays are unknown.

Moderately preterm birth is associated with poorer performance in intelligence, attention, visuospatial reasoning, and executive functioning. Using gender-specific norms, our data suggest that preterm boys catch up, whereas preterm girls lag behind their peers at 7 years of age. (Read the full article)

Changes in resident work hours are believed to have an impact on resident education and patient safety.

This study provides an understanding of the impact of changes in resident work hours on the staffing strategies of children’s hospitals. (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)

Children born late preterm (34–36 weeks’ gestation) are at increased risk of adverse early childhood outcomes compared with term-born children. The impact of the neonatal experience on longer-term outcomes of these infants has not yet been well considered.

This study provides information regarding the development of late preterm infants at 3 years. Late preterm infants who received neonatal intensive or high-dependency care had similar developmental outcomes to children born late preterm who did not receive this care. (Read the full article)

Healthy sleep is essential for supporting alertness and other key functional domains required for academic success. Research involving the impact of modest changes in sleep duration on children’s day-to-day behavior in school is limited.

This study shows that modest changes in sleep duration have significant impact on the behavior of typically developing children in school. Modest sleep extension resulted in detectable improvement in behavior, whereas modest sleep restriction had the opposite effect. (Read the full article)

The use of metformin in pregnancy is increasing in the treatment of both gestational diabetes and polycystic ovary syndrome. Metformin crosses the placenta. Teratogenicity is not reported. Possible long-term effects are undetermined.

Intrauterine metformin exposure seems to have long-term effects on infant weight. At 1 year of age, infants born to women and exposed to metformin weigh more than those exposed to placebo in utero. (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 rising burden of allergy is most evident in infancy, indicating the importance of early exposures. Reduced vitamin D status in pregnancy has been associated with atopy and respiratory outcomes, but there is less information on other early allergic outcomes.

Cord blood 25-hydroxyvitamin D₃ concentrations <50 nmol/L were highly prevalent in an Australian population. Lower vitamin D levels were associated with increased risk of eczema at 12 months of age, whereas there was no association with sensitization or food allergy. (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)

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)

Neonatal respiratory distress syndrome is the most common respiratory cause of mortality and morbidity among US infants aged <1 year. Although neonatal respiratory distress syndrome is a heritable disorder, common genetic variants do not fully explain disease heritability.

Single ABCA3 mutations are overrepresented among term and late preterm (≥34 weeks’ gestation) European-descent infants with RDS. Although ABCA3 mutations are individually rare, they are collectively common in the European- and African-descent general population, present in ~4% of individuals. (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)

Adolescent physical fighting is an important public health concern with known social origins. However, existing international studies of adolescent fighting provide little evidence about its prevalence, trends over time, or possible socioeconomic determinants.

We studied frequent physical fighting among 494 874 adolescents in 30 countries over an 8-year period. Physical fighting declined in most countries. National measures of absolute wealth but not socioeconomic inequalities related to risk of frequent physical fighting. (Read the full article)

Most observational studies from Western populations suggest that blood pressure is positively associated with low birth weight and faster infant growth; however, it is unclear whether these associations are biologically based or contextually specific.

In a developed non-Western setting with relatively little socioeconomic patterning of size or growth, birth weight and infant growth had relatively limited impacts on early adolescent blood pressure, which was more strongly related to recent growth and current size. (Read the full article)

There is widespread belief that many hospital readmissions in adults are avoidable by improvements in care and discharge planning processes, resulting in significant cost savings; however, current studies have not examined the preventability of such readmissions in children’s hospitals.

The overall rate of pediatric 15-day readmissions considered to be preventable was low, less than 2% of total hospital admissions. Pediatric readmissions are unlikely to serve as a highly productive focus for cost savings or quality measurement. (Read the full article)

Low birth weight (LBW) infants (<2500 g) are at risk for cognitive and behavioral problems later in life. During infancy, they are also at risk for iron deficiency, which has been associated with impaired neurodevelopment in other high-risk groups.

Iron supplementation during the first 6 months of life to LBW infants reduces the risk of behavioral problems at 3.5 years. Mild iron deficiency in infancy may be an important, preventable contributor to behavioral problems in children born with LBW. (Read the full article)

Cow’s milk consumption has opposite effects on vitamin D and iron levels in children; however, the amount of cow’s milk intake required for sufficient stores of vitamin D and iron is poorly understood, and existing guidelines on consumption are unclear.

Two cups of cow’s milk per day is sufficient to maintain healthy vitamin D and iron stores for most children. Wintertime vitamin D supplementation appears particularly important among children with darker skin pigmentation. (Read the full article)

Infants and toddlers with deformational plagiocephaly (DP) score lower on developmental measures than children without DP and lower than expected relative to test norms.

This study is the first to examine developmental outcomes in preschool-aged children with DP relative to demographically similar children without DP using a standardized, clinician administered assessment. (Read the full article)

First drink before age 15 greatly increases the likelihood for later alcohol abuse or dependence. Separate investigations have linked many variables to alcohol initiation, but few have attempted to identify the optimal combination of predictors for age of alcohol initiation.

This article supports the screening questions selected in the joint National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics initiative to identify and initiate intervention in youth at risk for early use of alcohol. (Read the full article)

Previous studies suggest that hospitals under the greatest financial strain may be more prone to adverse events because they have limited resources to invest in quality and safety.

The patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories. (Read the full article)

Effective interventions are still elusive for the large numbers of children affected by overweight/obesity. The value of targeting physical activity (PA) remains unclear because its predictive relationship with improved BMI is still surprisingly poorly quantified.

In overweight and mildly obese children presenting to primary care, 3-year changes in PA (especially the moderate-vigorous component) predicted BMI outcomes. However, the effect was small, possibly explaining the disappointing BMI outcomes of brief primary care interventions targeting PA. (Read the full article)

Care coordination has been proposed as a key mechanism for increasing quality and reducing costs of care. Little is known about the degree to which disparities exist in care coordination or whether having high-quality primary care attenuates disparities.

A considerable proportion of parents reported unmet care coordination needs for their children, especially parents of children with special health care needs. Black and Latino children also may have more unmet needs because they received family-centered care less often. (Read the full article)

Pediatric training programs use simulation for procedural skills training. Research demonstrates student satisfaction with simulation training, improved confidence, and improved skills when retested on a simulator. Few studies, however, have investigated the clinical impact of simulation education.

This is the first multicenter, randomized trial to evaluate the impact of simulation-based mastery learning on clinical procedural performance in pediatrics. A single simulation-based training session was not sufficient to improve interns’ clinical procedural performance. (Read the full article)

In the era of widespread conjugate vaccine use, the prevalence of bacterial meningitis has declined. However, the impact of this decline on the rate of emergency department visits for viral meningitis and cost of caring for these children is unknown.

There was a decline in the rate of diagnosis of viral meningitis in US children’s hospitals between 2005 and 2011. Most children diagnosed with viral meningitis are treated with antibiotics and are hospitalized, accounting for considerable health care costs. (Read the full article)

Medications used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children younger than 1 year. There are strong indications that GERD is overdiagnosed and overtreated.

The factors that drive overtreatment of GERD are not well understood, but it has been proposed that the use of the GERD disease label could perpetuate use of medication. In this study we find evidence for this possibility. (Read the full article)

Delayed anaphylaxis, urticaria, and angioedema to mammalian meat products were first described in the adult population in 2009. Patients with this syndrome who consume mammalian meat typically develop symptoms 4 to 6 hours after ingestion.

Specific diagnoses for children who develop urticaria, angioedema, and idiopathic anaphylaxis are few and far between. We have now shown delayed anaphylaxis, urticaria, and angioedema due to mammalian meat products in the pediatric population. (Read the full article)

Some Western studies show early introduction of solid food is associated with subsequent obesity. However, introduction of solid food and obesity share social patterning, making these observations vulnerable to residual confounding.

In a non-Western developed setting, there was no clear association of the early introduction of solid food with childhood obesity. Studies in populations with a different confounding structure may be valuable in clarifying and reconciling potentially confounded epidemiologic associations. (Read the full article)

Clinically significant bleeding in pediatric immune thrombocytopenia (ITP) is rare. Evidence-based guidelines for the management of pediatric ITP recommend that patients with mild or no bleeding be followed with observation alone.

Many pediatric patients with newly diagnosed ITP continue to be managed in the inpatient setting. Bleeding events are rare in this setting. Although geographic variability exists, intravenous immunoglobulin is the most commonly used inpatient ITP treatment in the United States. (Read the full article)

Research has shown that dishware size influences self-served portion sizes and meal intake in adults. In children, larger bowls led children to request more food, but whether larger dishware affects children’s self-served portions or intake at meals is not known.

We assessed the effect of increasing dishware size on self-served portions and intake in young children. Larger plates and bowls resulted in larger self-served portions, and indirectly promoted greater intake, emphasizing the importance of age-appropriate dishware. (Read the full article)

Advances in the treatment of critically ill infants have increased survival of extremely low/very low birth weight and medically complex infants. Improved survival can result in prolonged mechanical ventilation and sometimes tracheostomy. Current tracheostomy rates for these infants are unknown.

This long-term review of infants discharged from a NICU with tracheostomies is the first to describe tracheostomy rates specifically in extremely low/very low birth weight infants. It focuses on long-term clinical outcomes and comorbidities rather than surgical complications. (Read the full article)

The incidence of childhood and adolescent melanoma has been significantly increasing up to 2004. Risk factors (fair skin, light-colored hair/eyes, female gender, presence of nevi, family history, increased number of sunburns, and exposure to UV radiation) are associated with melanoma.

This study describes incidence trends of melanoma diagnosed between the ages of 0 and 19 years and from 1973 through 2009 by gender, stage and age at diagnosis, primary site, and exposure to UV radiation. (Read the full article)

Previous studies have suggested that health care providers, family members, friends, and others play a role in shaping parents’ vaccination decisions. Other research has suggested that the media can influence whether parents decide to vaccinate their children.

Through the application of social network analysis, this study formally examines and quantifies how parents are influenced by the people and sources around them. Its findings suggest that social networks are important, particularly for parents who do not completely vaccinate. (Read the full article)

Electronic health record (EHR) uptake by US hospitals has been slow, including among children’s hospitals. The Health Information Technology for Economic and Clinical Health program, which began in 2011, offers incentives for adoption and meaningful use of EHRs.

Using an annual survey, we evaluated how children’s hospitals have progressed in EHR adoption from 2008 through the start of the Health Information Technology for Economic and Clinical Health program and assessed their ability to meaningfully use EHRs. (Read the full article)

Cognitive and motor developmental test scores of preterm and late preterm infants increase with gestational age. Developmental test scores in full-term infants have not previously been considered to relate to gestational age.

In a cohort of healthy, full-term infants, 37 to 41 weeks, 12-month mental and psychomotor scores on the Bayley Scales of Infant Development increased with gestational age, suggesting that neurodevelopment is optimal in infants born at 39 to 41 weeks. (Read the full article)