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)

Media reports suggest that adolescents are being charged with sex crimes and even placed on sex offender registries because of participating in the "sexting" of sexual images, but the nature and outcomes of such incidents have not been described empirically.

This is the first study to examine types of sexting cases handled by police. It informs clinicians by identifying characteristics of "aggravated" versus milder incidents and finding that most youth were not arrested. Sex offender registration was rare. (Read the full article)

Most childhood HIV is acquired through perinatal transmission, some of which is preventable. Practitioners need to understand what proportion of perinatally acquired HIV infections are attributable to missed prevention opportunities.

Missed prevention opportunities include lack of early HIV testing for pregnant women; suboptimal use of antiretroviral medications during pregnancy, labor, or delivery or for the neonate; breastfeeding; and vaginal delivery when maternal viral load was ≥1000 copies/mL. (Read the full article)

Pediatric weight gain is a critical aspect of the obesity epidemic. Chronic stress produces physiologic perturbations capable of altering brain mechanisms related to eating as well as those implicated in self-regulatory behaviors.

We show that early childhood risk exposures are associated with weight gain in adolescence, independent of childhood BMI. We also find that deficiencies in self-regulatory processes help explain the link between chronic stress and adiposity. (Read the full article)

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a progressive, inherited neuromuscular disease manifesting with diaphragmatic paralysis in the first year of life. All patients need mechanical ventilation.

We describe the natural course of SMARD1, developed a scoring system, and defined prognostic values. The clinical outcome of the patients was heterogeneous, and residual enzymatic activity of the IGHMBP2 protein was associated with a more benign disease course. (Read the full article)

Blood pressure and heart rate are altered by sleep state and postnatal age in healthy term and preterm infants. Preterm infants have altered blood pressure responses to head-up tilting during sleep.

Preterm birth has marked effects on the maturation of baroreflex sensitivity during sleep, which may contribute to the greater vulnerability of preterm infants to sudden infant death syndrome. (Read the full article)

Chorioamnionitis is associated with preterm birth and an increased risk of common adverse outcomes of prematurity, including early-onset sepsis and neurodevelopmental impairment. The effect of chorioamnionitis on postnatal immune function and risk of late-onset infection is unknown.

Chorioamnionitis, which complicates many preterm births, is independently associated with a significantly reduced risk of late-onset sepsis in preterm infants. The findings suggest that chorioamnionitis may modulate the development of postnatal immunity in a clinically significant manner. (Read the full article)

Clinical trials in children with severe traumatic brain injury (TBI) are challenging. To date, no work has been published that permits clinical investigators to estimate the number and compositional features of sites from which to recruit children with severe TBI into clinical trials.

Children with severe TBI are infrequent. Less than 5% of all US hospitals discharged more than 78% of severe TBI cases. To maximize enrollment efficiency for future clinical trials, attention has to be paid to selecting appropriate hospital sites. (Read the full article)

The medical home is associated with beneficial outcomes in children with special health care needs and in the entire pediatric population. It is unknown if it benefits the majority of the pediatric population (ie, children without special health care needs).

This study is the first to demonstrate an association between the medical home and beneficial health care utilization, child health, and health-promoting behavior outcomes in children without special health care needs. (Read the full article)

Available clinical prediction rules to identify children with cerebrospinal fluid pleocytosis at low risk for Lyme meningitis include headache duration, cranial nerve palsy, and percent cerebrospinal fluid mononuclear cells. These rules require independent validation.

These clinical prediction rules accurately identify patients at low risk for Lyme meningitis in our large multicenter cohort. Children at low risk may be considered for outpatient management while awaiting Lyme serology. (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)

Although there is some older literature examining how arrest prevalence accumulates through adolescence and adulthood, there is no contemporary research examining the arrest histories of a representative sample of American youth.

Using a contemporary US sample of adolescents and young adults, we estimated the cumulative arrest prevalence through age 23. The results suggest a substantial increase in the cumulative prevalence of arrest since the 1960s. (Read the full article)

Overweight has been associated with an increased risk of asthma in children, although the published literature is contradictory. How change in overweight status during childhood affects asthma risk has not been well studied.

Among children whose weight has normalized, high BMI during the first 4 years of life does not increase the risk of asthma at school age. Current high BMI is associated with increased risk of asthma and sensitization to inhalant allergens. (Read the full article)

The quality of the relationship between mother and child affects the child’s neurodevelopment, emotion regulation, and stress response. Extreme or sustained stress responses are associated with dysregulation of physiologic systems involved in energy balance, which could lead to obesity.

The prevalence of obesity in adolescence was more than twice as high among those youth who in early childhood had poor-quality relationships with their mothers compared with those with better relationships. (Read the full article)

Sleep problems are common during childhood, but screening for sleep problems in the clinic setting is often cursory. Moreover, there are few longitudinal studies examining the prevalence and persistence of sleep problems in young children.

Patterns of sleep problems vary across early development, but sleep problems arising in infancy persist in 21% of children through 36 months of age. Parent response to a nonspecific query about sleep problems may overlook relevant sleep symptoms and behaviors. (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)

Eating disorders are characterized by preoccupation with weight and shape, which is manifested by a refusal to maintain a normal weight. An exact determination of expected body weight (EBW) is critical for diagnosis and clinical management of these disorders.

The McLaren and Moore methods present with several limitations when calculating EBW for adolescents with eating disorders. A commonly agreed upon method for EBW calculation such as the BMI percentile method is recommended for clinical and research purposes. (Read the full article)

Several studies have focused on birth weight heritability, reporting results that range between 40% and 80%. Few studies have focused on the process of weight gain and were mainly based on heterogeneous samples of infants.

The present work looks at a uniform set of healthy preterm newborn twins. The resulting high heritability estimate could suggest using the inclusion criteria to identify genes that regulate postnatal weight gain or failure. (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)

Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume–outcome relationship.

A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. (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)

The retention and use of residual bloodspots is a practice of many state newborn screening programs. This practice has become controversial, and little is known about public attitudes on the retention and research use of newborn residual bloodspots.

This study offers a detailed analysis of public attitudes regarding bloodspot retention and use for biomedical research. The results also offer insights on how education regarding this practice influences support for newborn screening and residual bloodspot use. (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)

Asthma is a common obstructive pulmonary disease experienced during pregnancy. Clinical guidelines recommend women with asthma maintain asthma medication use during pregnancy. Epidemiologic studies suggest an association between several types of defects and asthma or asthma medication use during pregnancy.

Data from a large, population-based, multicenter, case-control study was used. This provides the opportunity to study specific birth defects with minimal heterogeneity in case groups, as well as control for a variety of potential confounders. (Read the full article)

Studies of the association between process and outcome measures of the quality of acute asthma care for children have been mixed. These studies are limited by small, single-institution settings or by examining the association at the aggregate level.

This first multicenter analysis of the process-outcome association in acute asthma care for children revealed no association. Because the validity of process measures depends on association with outcomes, further study is needed before implementing existing process measures as performance metrics. (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)

Necrotizing enterocolitis (NEC) can present within the first week of life in term infants. In preterm infants, NEC usually appears after commencement of feeds and can occur between 2 and 3 weeks of life.

Among infants <33 weeks’ gestation, NEC appears to occur at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower gestational age infants. (Read the full article)

Childhood UV light exposures, specifically sunburns, have been shown to be associated with melanoma development later in life.

To date, most studies in this age group have been cross sectional in nature. This is the first prospective study of sunburn and sun behaviors in this age group. (Read the full article)

Previous research has demonstrated that young children with traumatic brain injury are at elevated risk of poor outcomes, particularly following severe injuries. These deficits persist until at least 5 years postinsult. Factors predicting outcomes in this age group have not been established.

This study follows survivors of very early traumatic brain injury into adolescence. Results indicate that severe injury is associated with poorest outcome, but after 3 years, the gap between children with severe traumatic brain injury and peers stabilizes. (Read the full article)

Epilepsy/seizure disorder is known to be associated with a range of mental health and neurodevelopmental comorbidities, based on clinical studies, and on population studies largely conducted outside the United States.

In a nationally representative sample of US children, estimated prevalence of reported lifetime epilepsy/seizure disorder was 1%, and of current epilepsy/seizure disorder was 6.3/1000. Developmental, mental health, and physical comorbidities are common, warranting enhanced surveillance, and an integrated service approach. (Read the full article)

Although follow-up examinations are recommended for suspected victims of sexual abuse or assault, little is known about the potential benefits of a second examination with regard to diagnosing trauma or sexually transmitted infections.

In ~23% of pediatric patients evaluated for sexual abuse or assault, a second examination by a specialist changed the interpretation of trauma likelihood or results in the detection of a sexually transmitted infection. (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)

Booster seat use improves seat belt fit and reduces risk of injury for children <57 in tall. Booster seat use decreases between ages 4 and 8 years. Children observed riding with other children frequently do not use booster seats.

In this national survey of parents, we found that a majority of parents of 4- to 8-year-old children carpool, and when they carpool booster seat use is inconsistent. Social norms and self-efficacy appear to influence booster seat use when carpooling. (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)

Limited data exist about the frequency and incidence of serious injuries due to physical abuse of children. Data from Child Protective Services, which are published yearly, do not have information about severity.

This is the first study to provide US estimates on the occurrence of serious injuries due to physical abuse. The incidence was highest in infants on Medicaid. Such data can be used to track changes due to prevention. (Read the full article)

There are a number of effective interventions designed to prevent childhood/adolescent depression. Such interventions tend to comprise screening and the subsequent provision of psychological therapy. However, the cost-effectiveness of routinely providing such interventions at a population level is not known.

By using economic modeling techniques, this study shows that the population cost-effectiveness of such preventive interventions for childhood/adolescent depression is very favorable, although implementation issues, particularly around the acceptability to providers, need to be addressed before widespread adoption. (Read the full article)

Children undergoing stem cell transplantation are thought to be at risk for increased distress, adjustment difficulties, and impaired health-related quality of life. Few interventions to improve adjustment and quality-of-life outcomes in this setting have been tested.

The excellent outcomes observed in all patient groups, including controls, may be a result of improvements in standard supportive care. Stem cell transplantation may not be as demanding as previously thought to be, and children undergoing this procedure appear resilient to the challenge. (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)

Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight infants and contributes to morbidity and mortality.

Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants and persists to discharge in most survivors. Routine screening of these infants with echocardiography at 4 weeks of age identifies only one-third of those affected. (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)

There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.

This study combined systematic literature review and the Rand/University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care. (Read the full article)

Atherosclerotic cardiovascular diseases have roots in childhood. Modification of dietary fat intake influences serum lipid and lipoprotein concentrations. Reduction of saturated fat intake is recommended to promote cardiovascular health.

Dietary counseling had a beneficial effect on saturated fat intake from ages 7 months to 19 years. The counseling reduced serum low-density lipoprotein cholesterol concentrations in both genders. It also decreased computationally estimated concentrations of intermediate-density lipoprotein cholesterol, very low-density lipoprotein–triglycerides and apolipoprotein B in boys. (Read the full article)

Among extremely premature infants, survival has improved, but the rate of cognitive impairment has not. Impaired cognition is the most frequent developmental problem identified in survivors. Several antenatal factors have been associated with cognitive impairment, mostly related to social disadvantage.

In addition to social disadvantage, antenatal characteristics associated with cognitive impairment include maternal obesity and thrombosis of fetal stem vessels. Prenatal infection and inflammation were not associated with impaired early cognitive function among extremely preterm infants. (Read the full article)

Delayed umbilical cord clamping in premature infants has been associated with decreased rates of intraventricular hemorrhage; however, the mechanisms that explain this finding have not been described.

Premature infants with delayed umbilical cord clamping have improved superior vena cava blood flow over the first days of life. This may provide one of the mechanism(s) by which this technique reduces the incidence in intraventricular hemorrhage in this at-risk population. (Read the full article)

Vitamin D levels in the general population have decreased considerably over the past decade. The implications of maternal vitamin D insufficiency during pregnancy for offspring neurocognitive development remain unclear.

Studying a large sample and using a prospective longitudinal design, this study demonstrates a link between maternal vitamin D insufficiency during pregnancy and offspring language impairment. There was no association with childhood behavioral or emotional problems. (Read the full article)

Adolescence is a time of risk taking, with poor inner-city youth at greater risk than the general population for drug use, school failure, adjudication, and teen parenthood. Little is known regarding these youths’ perceptions and intentions in early childhood.

Poor inner-city children were surprisingly idealistic regarding their future. Despite this, by late adolescence most experienced 1 or more trajectory-altering events. Early childhood experiences, exposure to violence and poor home environment, were factors most strongly associated with these outcomes. (Read the full article)