Sleep-disordered breathing is associated with neurobehavioral morbidity in children. Prior related research has generally been cross-sectional or short (ie, 1–2 years) follow-up studies of a single symptom (ie, snoring, obstructive sleep apnea, mouth breathing), with limited control for confounders.

Sleep-disordered breathing was assessed as a trajectory of combined symptoms from 6 months to 69 months, in more than 11 000 children. Sleep-disordered breathing was associated with 40% and 60% more behavioral difficulties at 4 and 7 years, respectively. (Read the full article)

Breastfeeding and oral sucrose have shown an analgesic effect in premature newborn infants for minor painful procedures. Studies suggest that the analgesic properties of breast milk are superior to oral sucrose in term neonates.

For premature infants from 32 to 37 weeks, there is no significant difference in analgesic effect between breast milk and oral sucrose. Breast milk is a safe and natural method for pain relief in late preterm infants. (Read the full article)

Previous studies have identified barriers to providing optimal pediatric palliative care, including general communication issues between clinicians and family members. However, there is a paucity of data regarding the barriers specifically relating to advance care discussions.

This study identifies significant barriers to advance care discussions for children with life-threatening conditions. Clinicians perceive parental issues as the most common impediments to these discussions. Furthermore, providers believe that advance care discussions happen too late in the course of illness. (Read the full article)

The availability of rapid response systems to assist deteriorating patients is the standard of care in children’s hospitals. Metrics for evaluating their effectiveness include cardiac and respiratory arrest rates, rare events that require years of data to show significant improvements.

A proximate outcome for in-hospital mortality among patients receiving rapid response system assistance was developed. This "critical deterioration" metric was eightfold more common than arrests and demonstrated criterion and construct validity, facilitating meaningful evaluation over shorter periods of time. (Read the full article)

Some studies reveal an association between exposure to alcohol consumption in movies and youth drinking, but the evidence is sparse.

Exposure to alcohol consumption in movies is associated with youth binge drinking, is little influenced by cultural differences between countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland), and is specific to movie alcohol, not movie smoking, depictions. (Read the full article)

Numerous late preterm infants undergo repetitive heel lancing procedures during their first hours of life to evaluate glycemic control. Heel lances are painful and 25% glucose solution is effective on reducing procedural neonatal pain scores and crying behavior.

This noninferiority randomized controlled trial demonstrated that compared with breast milk, 25% glucose provided lower pain scores and reduced duration of cry. Further research is necessary to clarify breast milk’s mechanisms and efficacy on neonatal pain relief. (Read the full article)

Preterm infants are at increased risk of behavioral problems, which has been associated with maternal distress. Paternal psychological well-being is less studied. Parents’ concerns may affect their perceptions or attitudes and have negative effects on the behavior of the child.

Parents report more behavior problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence. Also, the paternal psychological well-being contributes to the behavioral development of a preterm child. (Read the full article)

Stairs are a common source of injury to children. Most injuries are minor soft tissue injuries, with the head and neck region being injured most commonly.

This is the first nationally representative study of stair-related injuries to young children in the United States. A child aged <5 years is treated in a US emergency department, on average, every 6 minutes for a stair-related injury. (Read the full article)

Previous research on the cost of childhood autism has been restricted primarily to studying direct costs (money outlays) incurred by publicly and privately funded service systems.

This study estimates the economic impact on the family and examines indirect costs to families in the form of parental labor market productivity losses. (Read the full article)

Changes in BMI category appear to be common in young children and are associated with cardiometabolic risk in cross-sectional studies. However, there are few longitudinal studies and little information from multiethnic samples of US middle school children.

Findings demonstrate that shifts in BMI category are common in middle-school-aged children and associated with clinically meaningful changes in cardiometabolic risk factors. Programs to promote decreases in BMI, prevent increases, and moderate risk are indicated. (Read the full article)

Transcutaneous bilirubinometry was originally developed as a potential replacement for invasive blood sampling, but its clinical application is still limited to a screening method for hyperbilirubinemia. Reasons for this limited clinical value may be diverse.

This study provides insight into the reasons for the limited clinical value of transcutaneous bilirubinometry. This aids to both better interpretation of the measured TcB value from a patient and to possible improvement of the clinical value of the technique. (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)

Prenatal methamphetamine exposure has been related to deficits in fetal growth, changes in infant neurobehavior, and fine motor deficits, but little is known about its developmental effects on behavior problems in early childhood.

This is the first prospective study to identify behavior problems associated with prenatal methamphetamine exposure. Mood difficulties and acting-out behavior are increased in exposed children by age 3 years. Early identification and intervention may prevent escalation into delinquency and psychopathology. (Read the full article)

The survival of extremely low birth weight infants in resource-limited situations is dismal due to limited neonatal intensive care facilities. Nasal continuous positive airway pressure resulted in an increased survival of these infants, but many still require back-up ventilation.

Nasal continuous positive airway pressure and intubation, surfactant, and extubation practiced in a neonatal high care ward with limited resources and limited back-up ventilatory facilities can improve the survival of extremely low birth weight infants. (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)

Cross-sectional studies have shown an increased risk of mental health difficulties in children with developmental coordination disorder. However, there has been limited longitudinal research in this area controlling for confounding factors and assessing the role of potential mediators.

Children with "probable" developmental coordination disorder at 7 years had a significantly increased risk mental health difficulties at 10 years. Protective factors for self-reported depression included high IQ, high self-esteem, good social communication skills, and the absence of bullying. (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)

Subjects born preterm have higher blood pressure (BP) in childhood and adolescence. Little is known about at what age the deviation from normal BP starts, and data are especially scarce for the new generation of survivors after extremely preterm birth.

In a population-based study, we found that BP was higher in 2.5-year-old children born extremely preterm compared with controls. This finding might have implications for follow-up programs after preterm birth, with the goal of improving later cardiovascular health. (Read the full article)

Tenfold medication error is a well-recognized risk of pharmacotherapy in pediatric practice but little evidence describes the circumstances of such errors.

This study identified 252 tenfold medication errors, 22 of which resulted in patient harm. We identified opioids and other high-risk medications to be associated with tenfold medication error and frequent, recurrent causes, mechanisms, and error enablers that suggest areas for future improvements. (Read the full article)

Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. It is well known that effective asthma management depends on patient adherence to treatment. The authors of previous cross-sectional studies have linked CAM use with decreased adherence to conventional asthma treatment regimens.

This longitudinal data set was unique, allowing us to focus on patients who initiated CAM and to follow subsequent asthma medication adherence. We found that CAM use was not associated with adherence, suggesting that patients may practice CAM alongside conventional therapies. (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)

Preterm, growth-restricted infants are at high risk of necrotizing enterocolitis (NEC). NEC occurs most frequently in infants who have received enteral feeds. It is common practice to delay introduction of enteral feeds in these infants.

Early introduction of enteral feeds results in earlier achievement of full enteral feeding. Early feeding is not associated with a higher risk of NEC. Delayed feeding is associated with a higher risk of cholestasis. (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)

Alcohol consumption during adolescence and early adulthood has been associated with an increased risk of biopsy-confirmed benign breast disease (BBD), an established risk factor of breast cancer.

This is the first study to analyze the association between adolescent alcohol consumption and risk of biopsy-confirmed proliferative BBD by adolescent folate intake. The result provides no evidence for protective effects of adolescent folate intake on risk of alcohol-associated BBD. (Read the full article)

The presumed causes of neonatal deaths globally have remained unchanged over the past decade and include infections (~30%), prematurity (~30%), and asphyxia (~25%). Great uncertainty surrounds these estimates and, in addition, cases are likely misclassified as stillbirths.

These observational findings indicate that asphyxia accounts for a much higher percentage (60% of early deaths). Prematurity (18%), low birth weight (8%), and overt infection are much less common. The 5-minute Apgar score is an unreliable indicator of birth asphyxia. (Read the full article)

Estimates of youth participation in strangulation activity, commonly referred to as the "choking game," range from 5% to 11%. Previous studies have documented correlations between youth choking game participation and health risks such as substance use and mental health issues.

Among Oregon eighth-graders surveyed, >6% had ever participated in the choking game. Participation was linked to poor nutrition and gambling among females, exposure to violence among males, and sexual activity and substance use among both genders. (Read the full article)

Cumulative social factors in childhood have been associated with obesity in adulthood. Little is known regarding the role of accumulation of social stressors and obesity in early life.

Cumulative social adversities were associated with increased odds of early-onset obesity among girls. In addition, those with a higher number of stressors at a single time period had elevated odds for obesity by 5 years of age. (Read the full article)

We know that many evidence-based treatments for acute asthma are underused, and adherence with treatment guidelines is poor; however, studies have focused on β₂ agonists and corticosteroids, but little is known about intravenous magnesium, which has substantial evidence of benefit.

Magnesium is used infrequently in Canadian pediatric emergency departments in hospitalized children with acute asthma, with variation across sites. More than half of this population does not receive frequent bronchodilators and timely corticosteroids. (Read the full article)

As a result of safety and environmental concerns about mercury, aneroid sphygmomanometers have replaced mercury-filled devices for blood pressure measurements. Despite this change, few studies have compared the 2 devices.

Little clinical variation exists between blood pressure measurements obtained from an aneroid or mercury device, suggesting that either device could be used in a research or clinical setting. (Read the full article)

Cross-sectional studies have demonstrated associations between the white matter injury and cognitive impairment in very preterm born children. Longitudinal studies confirmed the relationships between cerebral MRI at term and neurodevelopmental outcomes at up to 2 years old.

White matter injury (but not gray matter injury) on term MRI predicted cognitive impairments of very preterm born infants at 9 years old. Qualitative assessment of white matter signal intensities showed limited predictive values of cognitive impairments. (Read the full article)

Although several randomized trials have examined the efficacy of serotonin receptor inhibitors in the treatment of repetitive behaviors, there still remains clinical uncertainty as to whether these agents are effective in treating such behaviors in children and adults with autism spectrum disorders.

The goal of this meta-analysis was to examine randomized trials of serotonin receptor inhibitors for treating repetitive behaviors in autism spectrum disorders. Although a small but significant effect of these agents was observed, this effect is likely due to the selective publication of trial results. (Read the full article)

We lack prospective studies documenting "dosage effects" of chronic child maltreatment for both subsequent adolescent and adult outcomes. It is unknown whether effects are linear, shelving, or exponential, and we lack data across domains of outcomes.

Chronic child maltreatment reports are a robust indicator of future negative health and behavioral outcomes. There is a dose-response relationship between chronicity and outcomes in adolescence, but this is attenuated in adulthood once adverse child outcomes are controlled. (Read the full article)

Following a rapid increase from 1980 to 2001, the prevalence of obesity among school-age children and adolescents in the United States has plateaued. Few studies have examined obesity trends among younger children in the past decade, and findings are inconsistent.

Among children aged <6 years at this multisite pediatric practice, the prevalence of obesity was fairly stable during 1999–2003, but substantially decreased during 2004–2008. This decrease was smaller among children insured by Medicaid than children insured by non-Medicaid health plans. (Read the full article)

Existing clinical research policy does not guarantee availability of results. Registration on the Web site ClinicalTrials.gov and the Food and Drug Administration Amendments Act improved transparency in pediatric clinical research. Registration and publication remain voluntary for many trials involving children.

Only 29% of completed registered studies and 53% of National Institutes of Health–funded trials involving children were published. Numbers of studies are increasing. Registration and posting of results on ClinicalTrials.gov should be mandatory for all studies involving children. (Read the full article)

The National Vaccine Advisory Committee highlighted the importance of settings complementary to the medical home for immunization delivery among adolescents, including school-based health centers (SBHCs). The effectiveness and cost of recall for immunizations in SBHC settings has not been studied.

SBHC-based recall was effective in improving immunization rates among adolescents, with effects sizes exceeding those achieved in practice settings. Average costs per child who was immunized ranged from $1.12 to $2.34 in 3 schools, but was $6.87 in 1 school. (Read the full article)

Disparities in outcomes of ethnic minority children have been reported, and have been ascribed to having barriers to access to health care. Minority parents have indicated that difficulties in access are because of problems with transportation and being non-English speaking.

This population-based study of Texas infants with severe congenital heart disease reports that neither home distance from a cardiac center nor Hispanic children having a Latin American–born parent were risk factors for first-year mortality. (Read the full article)

Conflicting results exist concerning long-term outcome in healthy infants with metabolic acidosis at birth.

Neonates who appear well after perinatal metabolic acidosis do not have an increased risk of neurologic or behavioral problems in need of referral actions or pedagogic arrangements at the age of 6.5 years. (Read the full article)

Youth violence and alcohol misuse are a preventable public health problem. Previous studies have demonstrated the efficacy of brief interventions in the emergency department (ED) in reducing alcohol misuse and related consequences among older adolescents and adults.

This study supports the efficacy of brief interventions in the ED in reducing peer aggression and victimization 12 months after ED visit. The previous reductions in alcohol consequences noted at 6 months follow-up were not sustained at 12 months. (Read the full article)

Overweight and obese children have a higher prevalence of several cardiovascular disease (CVD) risk factors. There is growing evidence demonstrating that CVD risk factors present during childhood persist into adulthood.

US adolescents had no significant change in prehypertension/hypertension and borderline-high/ high low-density lipoprotein cholesterol prevalence from 1999–2000 to 2007–2008; however, prediabetes/diabetes increased by 14%. (Read the full article)

Traditional health-risk behaviors, such as problem drinking, smoking, marijuana use, and unsafe sexual behavior are interrelated and not isolated events in the life of adolescents. New health-risk behaviors are emerging: risky music-listening behaviors, which may induce hearing loss.

Risky music-listening behaviors are highly associated with traditional health-risk behaviors. Risky MP3-player listeners are often cannabis users. Frequent visitors of music venues are less often cannabis users, but are often binge drinkers and have sexual intercourse without using a condom. (Read the full article)

Neonatal follow-up programs are designed in part to identify developmental delays among high-risk infants after NICU hospitalization and make referrals to state-funded early intervention. Early intervention has been shown to benefit children with developmental delays.

Many high-risk infants demonstrating developmental delays at neonatal follow-up programs are not referred to early intervention. Subspecialty clinics share responsibility with the medical home in referring children from birth through three years with developmental problems to early intervention services. (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)

Observation studies and short-term prospective intervention studies have shown that physical activity positively affects the accrual of bone mass and size during growth; however, fracture risk has not been evaluated.

This study reports the long-term results of a prospective intervention with increased physical activity at a population-based level and for the first time evaluated the clinical relevant end point, fracture risk. (Read the full article)

Although obesity is correlated with levels of systolic and diastolic blood pressure, there is little evidence if the increases in obesity over the last 40 years have resulted in increased blood pressure levels.

Despite increases in obesity in Bogalusa, Louisiana between 1974 and 1993, there was no increase in systolic or diastolic blood pressure levels. It should not be assumed that trends in high blood pressure have paralleled those for obesity. (Read the full article)

The causes of Perthes disease are unknown. There is considerable evidence that the disease has a vascular mechanism, although the nature of this is unknown. There is some suggestion that affected individuals may have a heightened cardiovascular risk in adulthood.

Children with Perthes disease have reduced vascular caliber, which is independent of body height, and abnormal functional vascular measures. These findings may be important in the mechanism of disease and may have implications on long-term vascular morbidity. (Read the full article)

Most mothers in the United States do not meet recommendations for exclusive breastfeeding; however, little is known about how long mothers intend to exclusively breastfeed or how hospital practices affect achieving these intentions.

Most mothers who want to exclusively breastfeed intend to do so for ≥3 months, but the majority are not meeting their intended duration. Mothers are more likely to achieve their intended duration when their infant is not supplemented in the hospital. (Read the full article)

Previous cohorts of extremely low birth weight adolescents have assessed their health status similar to that of normal birth weight controls.

Extremely low birth weight adolescents born in the 1990s assess their health similar to controls but report less risk taking. Extremely low and normal birth weight children rate their health to be poorer at 8 than at 14 years. (Read the full article)

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a significant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling.

We provide the first nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socioeconomic factors and access to health care affect whether adolescents receive these services. (Read the full article)

Neonatal hearing screening occasionally fails because of several perinatal and neonatal factors. However, the effect of mode of delivery on hearing screening has not yet been established.

We show significantly more failures on hearing screening in cesarean delivery infants. Hence, the timing of screening after cesarean delivery should preferably be postponed beyond 48 hours to improve success rate, minimize maternal anxiety, and decrease costs. (Read the full article)