Neuropsychiatric conditions comprise a substantial and growing disease burden among children. Pharmacotherapy represents an important treatment option for these conditions, although most drugs are not approved for use in children.

Very few drug trials studying neuropsychiatric conditions focus on children. Furthermore, these trials examine and provide pediatric evidence for only a fraction of all available drugs in the treatment of common neuropsychiatric conditions. (Read the full article)

Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.

Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. (Read the full article)

Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous large-scale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context.

We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. (Read the full article)

Yearly influenza immunization is recommended in patients with inflammatory bowel disease (IBD). However, concern regarding vaccine-related adverse events may limit uptake, and case reports in the literature detail disease flares after immunization.

Influenza immunization rates in children with IBD are low but immunization did not result in increased outpatient visits, hospitalizations or emergency visits. Immunization was associated with fewer IBD-related visits in the post-vaccine period, which may indicate protection against IBD symptoms. (Read the full article)

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)

Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.

Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment. (Read the full article)

Public health policy focuses on reducing formula use for breastfed infants during the birth hospitalization. Observational evidence supports this approach, but no previous studies have examined the effect of early use of small volumes of formula on eventual breastfeeding duration.

Use of limited volumes of formula during the birth hospitalization may improve breastfeeding duration for newborns with high early weight loss. Reducing the use of formula during the birth hospitalization could be detrimental for some subpopulations of healthy term newborns. (Read the full article)

Child welfare data show declines in child physical abuse since the early 1990s, but analysis of national data from hospitalized children in the Kids’ Inpatient Database showed an increased incidence of serious physical abuse in children from 1997 to 2009.

We found no significant change in hospitalization rates for injury from abuse in young children and increases in injury severity using the National Inpatient Sample from 1997 to 2009. This data helps provide a more complete perspective of the problem. (Read the full article)

Obesity is a growing concern for Mexican-American adolescents, with both behavioral and cultural variables that are related to the increasing trend.

These results highlight a patient-centered view of the emotional and physical burden of obesity in female Mexican-American adolescents, the families’ personal struggles with weight-related conditions, and the challenge of balancing family needs with those specific to the adolescent. (Read the full article)

Exemption rates for immunization requirements have until recently been stable in states permitting religious exemptions. States with easy exemption processes have seen higher rates of vaccine-preventable diseases.

In New York, the rate of religious exemptions has increased. Counties with higher rates of exemption have a greater incidence of pertussis. (Read the full article)

Bronchiolitis is often cited as the leading cause of hospitalization for young children in the United States Previous studies reported increases in bronchiolitis hospitalizations through the 1990s. There are no recent efforts to assess national trends in bronchiolitis incidence and health care utilization.

Between 2000 and 2009, we found a significant decline in bronchiolitis hospitalizations among US children. By contrast, use of mechanical ventilation and hospital charges for bronchiolitis significantly increased over this same period. (Read the full article)

Pediatric palliative care (PC) can be beneficial to children with life-threatening conditions and their families by providing symptom management and control, sibling support, bereavement services, spiritual guidance, support in decision-making about limiting burdensome medical interventions, and advance directives.

Little is known about actual receipt of PC by dying children. This study compares characteristics of dying children by receipt of PC and highlights underserved patient groups who could be targeted to improve access. (Read the full article)

Internet, smartphones, and online social media offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.

Caregivers in an urban pediatric primary care setting have access to and frequently use the Internet, smartphones, and online social media. These technologies may help reach a traditionally hard-to-reach population. (Read the full article)

Elevated blood pressure (BP) has long-term influence on the atherosclerotic process. The relative predictive ability of the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions has not been studied.

Simplified pediatric BP tables predict risk of high adult arterial stiffness as well as the complex table does. These simple screening tools could be used for identifying pediatric subjects at risk and for intervening to improve adult cardiovascular outcomes. (Read the full article)

Seizure-related death, including sudden death, is a frightening prospect. In part because risk and prevention are poorly understood, neurologists tend to avoid discussions of sudden death with families and young patients.

Most deaths in children with epilepsy are not seizure related. Relative to the population, however, sudden and seizure-related deaths alone double overall mortality. In uncomplicated epilepsy, such deaths occur at rates comparable to individual leading causes of death in young people. (Read the full article)

The ideal management of children with vesicoureteral reflux (VUR) remains a source of debate. There is little evidence to support many of the current management practices for children with VUR who have had 1 or 2 urinary tract infections.

Baseline associations, including bladder and bowel dysfunction and imaging studies, from the largest randomized, controlled trial conducted to date aimed at assessing the value of antimicrobial prophylaxis in children with urinary tract infection and VUR are presented. (Read the full article)

Patients who are fed via gastrostomy tube represent a heterogeneous, complex group of patients who may be at increased risk for kidney stones. To date, no previous studies have examined risk factors for kidney stone development in this population.

This case-control study of risk factors for urolithiasis in patients fed via gastrostomy suggests that topiramate use, urinary infections, and shorter length of time with a gastrostomy tube (possibly a marker for dehydration) are all associated with stone development. (Read the full article)

Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.

Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. (Read the full article)

Cognitive and behavioral problems after pediatric traumatic brain injury lead to poor functioning across multiple settings and can persist long-term after injury. Executive dysfunction is particularly common; however, there is a paucity of evidence-based interventions to guide treatment.

This study is among the largest randomized controlled trials performed in pediatric traumatic brain injury. It demonstrates the ability to use an online problem-solving-based intervention to improve caregiver ratings of executive dysfunction within 12 months after injury. (Read the full article)

Popular press and research show that sibling aggression is common. Too often, however, it is dismissed as benign, and other forms of child aggression, such as peer aggression, are considered more serious. Peer aggression is linked to poorer mental health.

Using a national probability sample, we show that the nature and severity of sibling aggression have negative links to children’s and adolescents’ mental health. We demonstrate that sibling and peer aggression are comparable their links to symptoms of distress. (Read the full article)

Obesity is associated with cardiometabolic risk factors and chronic conditions, such as type 2 diabetes. However, a proportion of overweight and obese youth remain free from cardiometabolic risk factors and are considered metabolically healthy.

This study provides insight into the determinants of cardiometabolic risk factors and the concept in health promotion of "fitness versus fatness." Hepatic lipid accumulation and not fitness level appears to drive cardiometabolic risk factor clustering among overweight and obese youth. (Read the full article)

Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.

CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings. (Read the full article)

Cornelia de Lange syndrome (CdLS) is a genetic syndrome with multisystem abnormalities. Infections are a significant cause of morbidity and mortality in affected patients and are typically attributed to anatomic abnormalities.

This study identified a high frequency of antibody immunodeficiency in CdLS subjects, indicating a critical need for screening and management of immunodeficiency in CdLS patients with a history of severe or recurrent infections. (Read the full article)

The incidence of necrotizing enterocolitis (NEC), a devastating condition in neonates, varies geographically and with time. Although the most consistent risk factors are prematurity and low birth weight, it has not been convincingly shown to increase in the postsurfactant era.

The incidence of NEC, especially among the highly premature but also in more mature groups, has increased in recent decades, concurrent with dramatically improved early infant survival. Seasonal variation of NEC suggests environmental etiological factors. (Read the full article)

Respiratory syncytial virus (RSV) infection is a leading cause of hospitalization among infants. Most estimates of RSV hospitalization rates are imprecise, having been calculated by using retrospective discharge diagnosis data and stratified age groups no narrower than 6 to 12 months.

Prospective, population-based surveillance data for infants hospitalized with laboratory-confirmed RSV infection were combined with birth certificate information to yield more precise age-specific hospitalization rates. These data should help determine priorities for the use of existing and future RSV prophylaxis strategies. (Read the full article)

Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.

Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. (Read the full article)

Effective ventilation is fundamental to successful resuscitation of newborns, but face mask leak and airway obstruction are common during manual positive-pressure ventilation in the delivery room, which may compromise resuscitation.

Compared with a soft, round silicone face mask, using a nasal tube to provide respiratory support in the delivery room does not reduce the rate of intubation but may be a suitable alternative with equivocal efficacy. (Read the full article)

Previous research on potential deleterious effects of typically developing children growing up in households with children with disability has produced mixed results. Research methods have been cited as a problem in many studies.

This is the largest known empirical study comparing functional impairment in siblings living with a child with disability and siblings residing with children who are typically developing. This study also follows the trajectory of functional impairment across 2 measurement periods. (Read the full article)

Blood cultures are a common investigation in children admitted to the hospital with skin and soft tissue infections. The yield of blood cultures in this condition is unknown.

Blood cultures are not useful in children admitted to the hospital with uncomplicated skin and soft tissue infections, and they may be associated with increased length of hospital stay. (Read the full article)

Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes.

This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. (Read the full article)

Evaluating for elevations in alanine aminotransferase (ALT) is a common screening test for the presence of nonalcoholic fatty liver disease (NAFLD). NAFLD is less common among non-Hispanic blacks. Better predictors of NAFLD are needed to identify individuals in most need of screening.

Relative to other ethnicities, metabolic syndrome and insulin resistance performed poorly at identifying non-Hispanic black adolescents with ALT elevations. The presence of metabolic syndrome may therefore not be an adequate trigger for NAFLD screening. Triglyceride elevations performed similarly between groups in identifying ALT elevations. (Read the full article)

At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood.

This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. (Read the full article)

Tympanometry provides a measure of middle ear function. There has been no description of the relationship between measurements of middle ear function in the absence of gross anatomic defects and clinical outcome among children with acute nontraumatic coma.

This study reveals an unexpected association between abnormal middle ear function and death in childhood acute coma. These findings call for more investigations on the relationship between middle and inner ear anatomy and function and intracranial dynamics and clinical outcomes. (Read the full article)

The intestinal microbiome may play a role in immune system maturation, and it has been postulated that early-life probiotic administration may reduce the risk of allergies and asthma in childhood. To date, however, results from clinical trials have been inconsistent.

In this meta-analysis, administration of probiotics in early life may reduce total immunoglobulin E level and protect against atopic sensitization but do not seem to protect against asthma/wheezing. Future trials should carefully select probiotic strains and include longer follow-up. (Read the full article)

Phthalate exposure has been associated with insulin resistance in animal studies and cross-sectional studies of adults, but has not been studied in adolescents.

We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents. The association is highly robust to multiple sensitivity analyses, and specific to phthalates commonly found in food. Further longitudinal study of dietary phthalate exposures is needed. (Read the full article)

Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)

Previous studies have reported that former late preterm infants are at increased risk for future learning and behavioral problems; thus it has been suggested that their development be closely monitored.

This population-based study indicates that the risk for attention deficit/hyperactivity disorder and learning disabilities may not be higher in former late preterm infants, and therefore intensive neurodevelopmental follow-up may not be required for all late preterm infants. (Read the full article)

Pulmonary embolism (PE) in the pediatric population is rare but does occur and is underrecognized. In adult emergency medicine, there are validated clinical decision rules derived to provide reliable and reproducible means of determining pretest probability of PE.

There are known risk factors, signs, and symptoms that should raise the clinician’s suspicion of pulmonary embolism, even in the pediatric population. (Read the full article)

The Faces Pain Scale–Revised and Color Analog Scale are self-report pain scales that are commonly used for children in the clinical and research settings.

The Faces Pain Scale–Revised and Color Analog Scale overall demonstrate strong psychometric properties in children 4 to 17 years of age, including within subgroups of age, sex, and ethnicity. Convergent validity, however, is questionable in children <7 years old. (Read the full article)

Abusive head trauma (AHT) is a type of physical child abuse, with infants at the highest risk. Parental characteristics associated with AHT include stress, young age, and current military service. However, a comprehensive evaluation of AHT among military families is lacking.

Risk factors and rates of AHT among military families are similar to civilian populations when applying a similar definition. Infants born preterm or with birth defects may have a higher abuse risk. (Read the full article)

Adult males are known to have a greater overall likelihood of death than female adults. Among children, excess male mortality is known for specific conditions but not as a general phenomenon.

Males are more likely to die during childhood and adolescence than their female peers from not only injuries but also from a wide variety of medical conditions, suggesting the existence of either a female robustness factor or a male vulnerability factor. (Read the full article)

Pediatric myasthenia encompasses a group of rare and underdiagnosed conditions affecting the neuromuscular junction. Symptoms include fluctuating skeletal muscle weakness, which can progress to respiratory failure if left untreated. The autoimmune form of this condition, in particular, is treatable.

This study describes the incidence, clinical features, diagnostic testing, and treatment trends of pediatric myasthenia in Canada, which have not been previously reported in the literature. (Read the full article)

The overall incidence of pediatric celiac disease (CD) is rising, as are other autoimmune conditions. Additionally, increasing numbers of children are older at the point of diagnosis and are diagnosed with CD through active screening.

Accounting for screened and nonclassic cases, there is an independent 2.5-fold rise in the incidence of classically presenting cases of pediatric CD (Oslo definitions). Thus, indicating a true rise in pediatric CD incidence in southeast Scotland in 20 years. (Read the full article)

Pediatric early warning scores (PEWS) for hospital inpatients have been developed to identify patients at risk for deterioration. Beyond triage, similar systems that identify ill patients and predict requirements for a higher level of care are needed in the emergency department.

The validity of the different PEWS in pediatric emergency care patients has never been evaluated. This study showed that PEWS are capable of detecting children in need of ICU admission. (Read the full article)

Preschool language delay is associated with poorer academic performance, more limited employment opportunities, and relationship difficulties. Despite its importance within public health, there has been little progress toward effective population-based prevention and intervention approaches to improve outcomes.

It is feasible to identify low language in 4-year-olds on a population basis and deliver a 1-on-1 intervention. By age 5 years, this resulted in better phonological awareness and letter knowledge. There was weak evidence of better expressive, but not receptive, language. (Read the full article)

Some infants presenting with bronchiolitis are later diagnosed with asthma. Corticosteroid treatment of all infants with bronchiolitis is not clearly efficacious.

We used infant eczema or asthma history in a first-degree relative to select patients with bronchiolitis for dexamethasone or placebo blinded treatment. Dexamethasone treatment of 5 days led to significantly earlier readiness for discharge from infirmary treatment. (Read the full article)

Invasive methicillin-resistant Staphylococcus aureus (MRSA) in children is associated with high morbidity and mortality. Although reductions in health care–associated MRSA infection among adults are documented, it is unclear if a similar trend is occurring among children.

Data from population-based surveillance were analyzed to assess changes in invasive MRSA infection incidence over time. This analysis describes the epidemiology and trends of invasive MRSA infections among children in 9 US metropolitan areas and estimates national burden. (Read the full article)

More than 70% of all preterm deliveries are late-preterm (34–36 weeks of gestation). Compared with those born at term, those born late-preterm have higher risk for medical and neurodevelopmental disabilities and suffer more often from mental and behavioral problems.

Late-preterm birth is associated with considerable lifetime socioeconomic disadvantages across the adult years. These disadvantages are not explained by childhood parental socioeconomic position. (Read the full article)

Traumatic brain injury (TBI) in children causes significant morbidity and mortality. Parental and coach awareness about brain injury due to sports has recently increased. Since 2001, pediatric emergency departments have seen a significant increase in sports-related TBI.

Pediatric, sports-related TBIs cared for in the emergency department and admitted to the hospital have both increased, resulting in no change in the percentage being admitted. However, patients admitted have had a significant reduction in injury severity. (Read the full article)

Previous studies have shown that nonmedical exemptions (NMEs) to immunization cluster geographically and contribute to outbreaks of vaccine-preventable diseases such as pertussis. The 2010 pertussis resurgence in California has been widely attributed to waning immunity from acellular pertussis vaccines.

This study provides evidence of spatial and temporal clustering of NMEs and clustering of pertussis cases and suggests that geographic areas with high NME rates were also associated with high rates of pertussis in California in 2010. (Read the full article)