Hospitalizations under observation status are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied.

Children’s hospitals use observation status with great variation. Resource utilization for pediatric patients under observation status overlaps substantially with inpatient-status utilization, calling into question the utility of segmenting pediatric patients according to billing status. (Read the full article)

Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.

This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings. (Read the full article)

Cross-sectional studies in children and adults have reported a significant positive association between attention-deficit/hyperactivity disorder (ADHD) and obesity.

This controlled, prospective, follow-up study of boys with ADHD found significantly higher BMI and obesity rates in adulthood, compared with men without childhood ADHD, regardless of socioeconomic status and other lifetime mental disorders. (Read the full article)

Physicians have little knowledge of health care costs and charges. Studies suggest that education and awareness of hospital finances can decrease unnecessary utilization of resources. Little is known about pediatricians’ awareness of the economics of health care delivery in the inpatient setting.

Both general pediatric attending physicians and trainees acknowledged a limited understanding of hospital finances, and they demonstrated a lack of awareness of costs, charges, and reimbursements for inpatient care. (Read the full article)

The remarkable improvement in the survival of extremely premature infants has been well documented. However, there have been few cohort studies large enough to determine the neurodevelopmental outcomes of survivors born at 22 or 23 weeks.

The proportions of unimpaired or minimally impaired were 12.0% at 22 weeks (n = 75) and 20.0% at 23 weeks (n = 245). The outcomes were inferior compared with those for infants born at 24 and 25 weeks, but were improved compared with those in previous studies. (Read the full article)

Pneumococcal conjugate vaccines are effective in preventing pneumococcal disease but are also costly. Although the current US immunization schedule recommends 4 doses, many countries have adopted 3-dose schedules that have worked well, but may provide less protection against pneumococcal disease.

Changing the US 13-valent pneumococcal conjugate vaccine schedule from 3 to 2 primary doses while keeping a booster dose would save $412 million annually but might lead to moderate increases in pneumococcal disease, especially otitis media and pneumonia. (Read the full article)

Many children exceed the American Academy of Pediatrics' recommendation to limit non-educational screen media to < 2 hours per day. The household media environment shapes children's television viewing (TVV), and heavy screen time is associated with poor health outcomes.

Parent TVV is a stronger predictor of child TVV than traditional media "access" and "rules" variables regardless of child age. This research highlights an important factor of child TVV that has been underemphasized in most studies and outreach efforts. (Read the full article)

Diabetic ketoacidosis (DKA) is a short-term complication of type 1 diabetes and is a major cause of preventable hospitalization in children. Hospital resource utilization and readmission rates for DKA across the US are not known.

Readmission for DKA within a year of hospitalization is common, accounting for one-fifth of all DKA admissions. Resource use, hospital length of stay, and readmission rates vary widely across major US children’s hospitals, even after adjusting for hospital differences in patients. (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)

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)

Although most US mothers initiate breastfeeding, half fail to achieve their breastfeeding intentions. In cross-sectional and retrospective surveys, early breastfeeding difficulties are often cited as reasons for stopping breastfeeding earlier than intended.

We characterized 4179 breastfeeding concerns/problems as reported by primiparas interviewed prospectively. Concerns were highly prevalent and associated with up to ninefold greater risk of stopping breastfeeding earlier than intended. Concerns at 3 to 7 days posed the greatest risk. (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)

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)

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)

Stable health insurance coverage facilitates access to health care. Despite expanded coverage options for children, parents report barriers to accessing insurance programs for their children, including uncertainty about a child’s coverage status and eligibility.

Electronic health records can be used as an emerging data source for conducting health insurance surveillance to track trends in patients’ insurance coverage status, and to identify patients who may benefit from outreach and support to obtain and maintain coverage. (Read the full article)

Although community engagement is considered an important professional role of physicians, there has been declining involvement of pediatricians in community child health activities. Whether enhanced training is associated with increased involvement is unclear.

This study reveals a continued decline in pediatricians’ involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians’ community involvement. (Read the full article)

Parents influence their child’s overweight development through lifestyle-related parenting practices. Although broader parenting dimensions may also affect children’s BMI, reverse causality is possible and there have been calls to examine the possible impacts of fathers.

More consistent parenting prospectively predicted lower child BMI with effects equally strong for fathers and mothers. There was little evidence of child BMI influencing parenting. Improved child BMI could be among the benefits of promoting parenting consistency of both parents. (Read the full article)

Youth are frequent consumers of movies that contain high levels of violence, and violent content in films, especially those rated PG-13, has been increasing over time.

Content analyses seldom examine how violence is portrayed with other health risk behaviors, such smoking, drinking, and sex. This study presents an innovative way to characterize on-screen violent content and demonstrates the extent to which risk behaviors co-occur within films. (Read the full article)

The management of term and near-term newborns suspected of early-onset sepsis, particularly when they are not clearly symptomatic, remains controversial. Methods for quantifying risk that combine maternal factors with a newborn's evolving clinical examination have been lacking.

This study provides a method for predicting risk of early-onset sepsis. It combines maternal risk factors with objective measures of a newborn's clinical examination and places newborns into 3 risk groups (treat empirically, observe and evaluate, and continued observation). (Read the full article)

Preterm infants are at an increased risk of regulatory difficulties during infancy and of behavioral problems in childhood. In the full-term population, persistent crying problems that last beyond 3 months of age have been related to later behavioral problems.

Excessive crying by a preterm infant may reflect an increased risk for later behavioral problems and higher parenting stress even years later. Therefore, it is clinically relevant to assess systematically the crying behavior of preterm infants. (Read the full article)

Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals.

In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. (Read the full article)

Infants with trisomy 13 (T13) or trisomy 18 (T18) are known to have poor survival. Little is known about how very low birth weight (VLBW) impacts survival and morbidities among infants with T13 or T18.

We examined the risks of mortality and neonatal morbidities for VLBW infants with T13 or T18 compared with VLBW infants with trisomy 21 and VLBW infants without birth defects in a 16-year cohort from the Neonatal Research Network. (Read the full article)

Sibship size has been negatively associated with children’s language, cognitive, and academic outcomes. This phenomenon is often explained in terms of resource dilution, wherein more children in the home is associated with fewer parental resources allocated to each child.

The current study identifies a moderator of this relationship. Specifically, if children’s next-in-age older siblings exhibit high levels of cognitive sensitivity then sibship size is not significantly related to children’s vocabulary. (Read the full article)

A growing body of research suggests that the food environment affects children’s weight. Specifically, living in areas with higher-priced fast foods and soda is associated with lower weight and BMI, whereas higher fruit and vegetable prices demonstrate the opposite association.

Using longitudinal data on lower-income young children, this study finds that higher-priced fruits and vegetables are associated with higher child BMI, but not food insecurity, and that this relationship is driven by the prices of fresh fruits and vegetables. (Read the full article)

Preterm infants must develop oral feeding skills before successfully transitioning to home. Pacifier-activated devices playing selected music can improve nonnutritive sucking in preterm infants. A mother’s voice is a positive auditory stimulus for infants.

A brief intervention with a pacifier-activated music player using mother’s voice can decrease tube feeding duration without adverse effects on stress or growth. Operant conditioning with positive reinforcement is an effective developmental strategy to improve preterm infants’ feeding skills. (Read the full article)

Early establishment of a dental home is critical for addressing the "silent epidemic" of early childhood caries. Physicians and dentists have worked to improve children’s access to dental care, but little is known about caregivers’ role in this context.

Addressing factors that affect the establishment of a child’s dental home, such as caregivers’ dental neglect and problem-driven care-seeking behaviors, is essential. Caregiver engagement seems to be pivotal for increasing use of preventive services while decreasing episodic and problem-initiated care. (Read the full article)

Inadequate nutrient intake can compromise a child’s nutritional status, which may affect immune function. Improving dietary intake via a follow-up formula may support appropriate immune responses and improve a child’s ability to resist infection.

Children who consumed an experimental follow-up formula had fewer episodes and shorter duration of acute respiratory infections, as well as less antibiotic treatment, and fewer days missed of day care due to illness. (Read the full article)

Invasive pneumococcal disease causes enormous morbidity in children. The spectrum and severity of illness caused by pneumococcal serotypes not present in the current vaccine, and whether the clinical profile and severity of disease have changed, are largely unknown.

Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. (Read the full article)

As the number of chronically ill children grows in the United States, end-of-life discussions and advance directives (AD) will become increasingly important. Although pediatric palliative care is gaining interest, little is known about parental preferences regarding ADs for chronically ill children.

Knowledge about ADs is limited among caregivers of children who have chronic illness. However, interest in creating ADs is high, suggesting an unmet need and opportunity for health care providers to improve the care of children who have chronic illness. (Read the full article)

Supplemented mother’s own milk is the preferred nutrition for very low birth weight infants.

Through targeted encouragement and guidance, most mothers are able to provide milk to their very low birth weight infants, both for early and prolonged feeding, in an open-bay NICU. (Read the full article)

Numerous studies have demonstrated clinical benefits of medical emergency team (MET) implementation, including reductions in mortality, cardiac arrests, and critical deterioration events. No studies have evaluated the financial costs and benefits of METs.

The costs of operating an MET can plausibly be recouped with a modest reduction in critical deterioration events. Hospitals reimbursed with bundled payments could see real financial savings by reducing critical deterioration events with a MET. (Read the full article)

There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed.

We observed wide variation in admission rates for common pediatric conditions across US children’s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department. (Read the full article)

Arthropod-borne viruses are important causes of neurologic infections among children in the United States. The epidemiology of these diseases is complex and relates to multiple factors, including vector biology, animal reservoirs, weather, and human behavior.

National surveillance data from 2003 to 2012 will improve understanding of the geographic, temporal, and clinical trends in pediatric neuroinvasive arboviral disease, and will inform decision-making for clinicians, public health authorities, and the general public. (Read the full article)

Messages emphasizing societal benefits of vaccines have been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children.

Findings suggest that health care providers should emphasize the direct benefits of MMR vaccination to the child. Mentioning societal benefits seems to neither add value to, nor interfere with, information highlighting benefits directly to the child. (Read the full article)

Little is known about how pediatricians communicate with overweight Latino children and their parents regarding overweight and obesity.

Findings suggest that many overweight Latino children and their parents do not receive direct communication that the child is overweight, weight-management plans, culturally relevant dietary recommendations, or follow-up visits. (Read the full article)

The built environment may affect weight status by presenting opportunities or barriers for exercise and nutritious eating. Although there is substantial cross-sectional evidence linking neighborhood factors and childhood obesity, causal uncertainty remains, owing to conceptual and methodological challenges.

This prospective study examined neighborhood influences on obesity during the transition to adolescence, a sensitive period for excess weight gain. Girls living in neighborhoods characterized by physical disorder or increased access to food and service retailers exhibited higher obesity risk. (Read the full article)

Studies have shown that setbacks, such as receiving low school grades, lead children to experience negative self-feelings (eg, shame, insecurity, powerlessness). Psychological theory predicts that unconditional regard can buffer this adverse impact of setbacks. However, causal evidence is lacking.

This randomized field experiment shows that briefly reflecting on experiences of unconditional regard buffers children’s negative self-feelings after an academic setback 3 weeks later. Unconditional regard may thus be an important psychological lever to reduce negative self-feelings in youth. (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)

Research suggests that appearance-focused messages and exaggerated depictions of sexual activity in the media negatively influence adolescents’ body and sexual self-perceptions. As adolescents increasingly use the Internet to explore their sexuality, health risks related to online behaviors should be identified.

This 4-wave study examined the prevalence and development of 2 receptive and 2 interactive sex-related online behaviors and their relations with adolescents’ body and sexual self-perceptions. It further investigated which parental strategies regarding Internet use may reduce risky sex-related online behaviors. (Read the full article)

The American Academy of Pediatrics has identified bedding such as pillows, blankets, and quilts as potentially hazardous for the infant sleep environment. Bedding use is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation.

Reported bedding use over or under the infant for infant sleep substantially declined from 1993 to 2010. However, about one-half of US infants are still placed to sleep with potentially hazardous bedding despite recommendations against this practice. (Read the full article)

Antibiotic overuse is common and is a major public health threat. The prevalence of antimicrobial stewardship programs in children’s hospitals is growing. Single-center studies reveal that antimicrobial stewardship programs are effective in reducing unnecessary antibiotic use. Multicenter evaluations are needed.

Antibiotic use is declining overall across a large network of freestanding children’s hospitals. Hospitals with formalized antimicrobial stewardship programs experienced greater reductions in antibiotic use than other hospitals, suggesting that these interventions are an effective strategy to address antibiotic overuse. (Read the full article)

Hospitalized pediatric patients are often exposed to many medications during an inpatient admission. Drug–drug interactions may increase the risk of developing medication-related adverse drug events, leading to serious clinical morbidity and mortality.

Exposure to "major" potential drug–drug interactions occurs in 41% of pediatric hospitalizations in children’s hospitals. One-half of all these exposures were due to less common specific drug pairs (≤3% of patients exposed per hospital day) and thus may be less clinically familiar. (Read the full article)

There is extensive literature documenting that children experiencing foster care placement have myriad adverse developmental outcomes, including poor academic achievement. However, such children face a host of other risk factors that may jeopardize healthy development independent of foster care placement.

Using statewide administrative data from Wisconsin, we observed children before, during, and after foster care placement and compared their educational outcomes with those of the general population, as well as with children more similar in terms of unobserved characteristics. (Read the full article)

Light and intermittent smoking are harmful, but increasingly common, smoking patterns. It is unknown how adolescents perceive these smoking patterns, and whether these views differ by sociodemographic characteristics, and exposure to and use of tobacco.

US adolescents perceive light and intermittent smoking as significantly less dangerous than heavier smoking. One in 4 adolescents believes intermittent smoking causes little to no harm. Perceptions of relative safety were common among smokers. (Read the full article)

Little is known about the mental health of extremely low birth weight survivors in their 30s. It is also unclear whether being born small for gestational age or being exposed to antenatal corticosteroids increases risk in this group.

In their 30s, extremely low birth weight survivors are less likely to have substance problems but are at elevated risk for other psychiatric disorders. Those born small for gestational age are at higher risk, but those exposed to antenatal corticosteroids are at the greatest risk of all. (Read the full article)

Preterm infants are at an increased risk of infections; therefore, vaccination is of particular importance. Because immune response data reported for preterm infants may vary according to gestational age and vaccination timing, vaccine responses in this population warrant additional research.

This study evaluated 13-valent pneumococcal conjugate vaccine in preterm infants. Results suggest that this vaccine was well tolerated and immunogenic; most subjects achieved serotype-specific immunoglobulin G antibody levels and functional antibody responses likely to correlate with protection against invasive disease. (Read the full article)

Existing literature discusses the unique medical and psychological needs of sex trafficking victims and highlights the importance of screening patients with risk factors. However, little is known about providers’ knowledge and confidence in their ability to provide care to victims.

The study summarizes the knowledge gaps and barriers providers face when assisting pediatric sex trafficking victims. It also highlights the impact of training on providers’ confidence and ability to appropriately care for victims. (Read the full article)

Burns are a leading cause of pediatric emergency department visits and hospitalizations and are often associated with significant long-term physical and psychological consequences and long-term medical and nursing treatments. Little is known of the long-term impacts of burns on mortality.

Children with burns had a 1.6 times greater rate of long-term mortality than a matched population-based cohort of children with no injury. Total mortality burden based on in-hospital deaths alone underestimates the true burden from both minor and severe burns. (Read the full article)

Micronutrient deficiencies, including deficiencies of vitamin B-12 and folate, are common worldwide and may be a contributing factor to the estimated 165 million stunted children.

Routine supplementation of vitamin B-12 improved linear and ponderal growth in subgroups of young Indian children. We provide evidence that vitamin B-12 deficiency is a contributor to poor growth in low- and middle-income countries. (Read the full article)