The prevalence of asthma and associated urgent medical visits vary dramatically across neighborhoods in New York City. Some, but not all, children with asthma wheeze when they exercise.

Exercise-induced wheeze was more common for asthmatic children living in neighborhoods with higher versus lower asthma prevalence. Because exercise-induced symptoms indicate a propensity for rapid-onset symptoms, this increased prevalence may contribute to the observed increase in urgent medical visits. (Read the full article)

Although survival of children born with Down syndrome has improved, unexplained racial and ethnic disparities in survival persist in the United States.

This study used population-based data from 10 birth defects monitoring programs in the United States to examine survival trends among children born with Down syndrome and to evaluate the changing influence of survival predictors over the life course. (Read the full article)

When research involving children is determined to present greater than minimal risk but no potential for direct benefit, permission is required from both parents, unless one is not reasonably available. These requirements are variably understood and applied, and guidance is lacking.

In a study on newborn screening, a sizeable percentage of fathers were not reasonably available, reflecting complexities of parental status and family relations. Guidelines developed in this project may provide tools for researchers and institutions to apply in other contexts. (Read the full article)

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

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

Studies have linked bullying with BMI, with overweight and obese youth vulnerable to bullying and its negative psychological and health consequences. However, there has been little comprehensive assessment of weight-based victimization, especially in weight loss treatment–seeking samples of youth.

WBV is prevalent in treatment-seeking youth, who report victimization from peers (92%), friends (70%), parents (37%), and teachers (27%). Providers should discuss WBV in their assessment and treatment of pediatric patients who are overweight or obese. (Read the full article)

Paternal mental disorders during the postnatal period are associated with an increased risk for behavioral and emotional problems in their children; however, less is known about the effect of fathers’ mental health during pregnancy on children’s development.

The study demonstrated a positive association between fathers’ prenatal mental health and their children’s subsequent socioemotional and behavioral development. Psychological distress in fathers was associated with a risk for emotional difficulties in their children at 36 months of age. (Read the full article)

Children born at very low birth weights have significant catch-up weight gain but differences in height remain. Their BMI, however, tends not to be higher than expected. Data are lacking regarding representative cohorts, defined by gestation and compared with contemporaneous controls.

In a geographic cohort of extremely preterm participants followed until age 18, compared with term controls, weight differences diminish over time, and height differences persist. BMI at age 18 is similar. Height at age 2 is a better predictor of final height than midparental height. (Read the full article)

Children with sickle cell anemia are at risk of central nervous system damage, including stroke. Even children without evidence of abnormality on neuroimaging are at risk of significant declines in neurocognitive function, starting at early ages.

This study adds the observation that poorer neurocognitive and behavioral function is associated with older age in infants and toddlers with sickle cell anemia, much earlier than previously expected. (Read the full article)

Complementary and alternative medicine (CAM) use is common among children, especially those with chronic, recurrent, or incurable conditions. Concurrent use of CAM with conventional medications is of concern and needs to be assessed, especially in vulnerable patient populations.

CAM use is high among pediatric cardiology, gastroenterology, neurology, oncology, and respiratory patients, most of whom use CAM concurrently with conventional care. This study provides additional evidence to suggest the use of CAM be included in routine patient history taking. (Read the full article)

Presleep activities (eg, television watching) have been implicated in the declining sleep duration of young people. However, previous research reported on selected presleep activities, raising the possibility that important activities in this period are not accounted for.

This is the first study in youth to construct the presleep period by using a use-of-time approach. Twin trajectories of higher screen time and lower nonscreen sedentary time/self-care were evident in late sleepers, with the opposite pattern occurring in early sleepers. (Read the full article)

Few reports have explored the measurement validity of the relative value unit (RVU) system, particularly in pediatrics. The RVU system, although broadly applied in health care settings, was developed for the adult population and thus may possess unique inadequacies in pediatrics.

We found deficiencies in the ability of the RVU system to capture features of case mix complexity and differences related to age. Additional investigation may be warranted to determine the validity of RVU as a measurement tool in pediatrics. (Read the full article)

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

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

The American Academy of Pediatrics recommends that infants <1500 g birth weight receive an iron intake of 4 mg/kg per day. There are no randomized trials to support this recommendation.

This trial compared the effect of iron supplementation of 2 mg/kg per day on the hematocrit at 36 weeks' postmenstrual age. This study concluded that iron supplementation does not affect the 36-week hematocrit or the number of transfusions in infants <1500 g. (Read the full article)

A number of studies have shown that home-visiting interventions can improve outcomes for children being raised in families that face multiple adversities. It is less clear how well these benefits are sustained over long periods.

The current study shows that the Early Start program of home visitation has benefits in terms of reducing child abuse, increasing parental competence, and improving childhood behavioral adjustment for up to 9 years, suggesting long-term benefits of home visitation. (Read the full article)

Bilateral acute otitis media (AOM) is considered more severe than unilateral AOM, and several guidelines recommend more active management of bilateral AOM. However, severity of symptoms and otoscopic signs of bilateral and unilateral AOM have previously not been comprehensively studied.

Bilateral AOM seems to be clinically only a slightly more severe illness than unilateral AOM. When assessing AOM severity, bilaterality should not be used as a determining criterion; instead, the child’s symptoms together with otoscopic signs should also be acknowledged. (Read the full article)

In inverse proportion to the steadily declining under-5 mortality rate, prevalence of childhood disability has doubled in the past decade in Bangladesh. The Rapid Neurodevelopmental Assessment (RNDA) tool has been shown to be reliable and valid for assessment of a range of neurodevelopmental impairments (NDIs) and disabilities in children younger than 2 years. There is currently a lack of professional expertise for assessing NDIs in 2- to 5-year-old children in low- and middle-income countries.

We developed a set of instruments as part of the RNDA for administration by a single professional with experience in child development to assess >2- to 5-year-old children for a wide range of NDIs. The tool was acceptable to mothers, interrater reliability was high, and proportions of children with NDIs were elevated among the lowest income groups and in stunted children, demonstrating discriminant validity. The RNDA was valid for identifying >2- to 5-year-old children with a range of NDIs, especially in cognitive, behavior, and motor functions. Validity of the RNDA for vision, hearing, and seizure disorders needs further research. (Read the full article)

Practice characteristics, such as practice size, have been associated with the readiness of adult primary care practices for medical home certification. Little is known about how ready primary care practices for children are for medical home certification.

Primary care practices for children attained only 38% of the infrastructure required for medical home certification. Smaller practice size was significantly associated with lower infrastructure scores. Medical home programs need effective approaches to support practices with limited resources. (Read the full article)

Peer victimization predicts numerous health risks. Lesbian, gay, and bisexual (LGB)-identified youth report greater peer victimization than do heterosexual-identified youth. No longitudinal studies have been conducted on developmental trends of peer victimization and emotional distress among LGB and heterosexual youth.

We provide the first longitudinal evidence on developmental trends of peer victimization and emotional distress for LGB- and heterosexual-identified youth. The findings suggest peer victimization of LGB-identified youth decreases in absolute, but not necessarily relative, terms and contributes to later emotional distress disparities. (Read the full article)

Provider training level is associated with lower rates of successful tracheal intubation in selected neonatal settings. However, little is known about the association of training level with tracheal intubation success and adverse events in the PICU.

Our results demonstrate the association of training level on the first attempt and overall success rate as well as the incidence of adverse tracheal intubation–associated events in a large-scale, prospective assessment across 15 academic PICUs. (Read the full article)

Research indicates that adolescents who perceive their school to have a positive socioeducational environment are at reduced risk of developing depressive symptoms. However, there is limited evidence that school environments can influence adolescent emotional health independently from individual perceptions.

This multilevel longitudinal study shows that better school socioeducational environments, as assessed at the school level, reduce the prospective risk of depressive symptoms in adolescents. This association is shown to be independent from confounders and stronger in girls than boys. (Read the full article)

Preterm born children have cognitive problems that include deficits in working memory. Computer-based working memory training has been reported to improve cognitive function in children.

A computer-based working memory training program designed for preschoolers seems effective in very low birth weight children, not only on working memory tasks, but also by having a generalizing effect regarding memory and learning. (Read the full article)

In humans, the brain growth spurt begins in the last trimester of pregnancy and extends through the first 2 years of life. Studies show poor cognitive and motor development among children who have iron deficiency anemia in infancy.

Prenatal iron deficiency anemia in the third trimester affects child mental development. Prenatal micronutrient supplementation with sufficient iron protects child mental development even when the woman’s iron deficiency anemia is not properly corrected during pregnancy. (Read the full article)

Impaired visual development has been reported in infants born to mothers prescribed methadone in pregnancy. Immature visual evoked potentials have been reported in this population, but data were confounded by gestation, growth restriction, and illicit drug use.

Visual evoked potentials are small and immature in infants exposed to methadone and other drugs of misuse in utero. These changes are independently associated with methadone exposure and persist after controlling for gestation, socioeconomic deprivation, alcohol consumption, and cigarette smoking. (Read the full article)

The presence of elevated cardiometabolic risk factors, such as obesity, high glucose or lipid levels, and smoking, in adolescents has been shown to be associated with earlier onset of chronic conditions, such as diabetes and heart disease.

Obesity, smoking, and elevated glucose increases the risk of dying before the age of 55 years. This is the first study to focus on risk factors and mortality among adolescents and young adults in a nationally representative US sample. (Read the full article)

Children have been shown to imitate behaviors they see on screen.

Modifying what children watch can improve their observed behavior. (Read the full article)

Isolated case reports of abnormal voice after extremely preterm birth are well described; however, there are no systematic studies of long-term voice outcomes in children born preterm.

Significant voice abnormalities were found in more than half of tested children born before 25 weeks’ gestation. Multivariable analyses showed that the number of intubations, not the duration of intubation, and female gender were strongly associated with this adverse outcome. (Read the full article)

Children with Lyme and septic arthritis of the knee may present similarly, although septic arthritis requires prompt treatment initiation to avoid joint destruction. Clinicians must make initial management decisions without Lyme serology and bacterial culture results.

Our clinical prediction rule accurately identified patients at low risk for septic arthritis in a Lyme disease–endemic area. In the appropriate clinical context, low-risk patients may be spared invasive testing such as diagnostic arthrocentesis. (Read the full article)

Rapid initiation of effective chest compressions (CCs) for patients in cardiac arrest improves outcomes, yet even trained rescuers fail to provide consistently effective CCs. Pediatric data on CC quality and objective measures of CC work are limited.

CC quality deteriorates similarly in pediatric and adult models, and overall work done to compress the pediatric chest is similar to that in adults. Power output during CC performance is analogous to that generated during intense exercise such as running. (Read the full article)

Studies of clinically derived samples of infants with failure to thrive have reported that children remain shorter and lighter than their peers at school-age. Enhanced weight gain ("catch-up") in small infants has been linked to subsequent obesity.

Infants with early weight faltering caught up in weight by 2 years, but height gain remained disproportionally slow. Those with weight faltering later in infancy remained shorter and lighter throughout childhood. Anthropometric outcomes of both groups were within population norms at 13 years. (Read the full article)

Reductions in infant mortality in the 20th century have not continued. Racial and socioeconomic inequalities in both infant mortality and sudden infant death syndrome (SIDS) persist. Rates of infant mortality in English-speaking countries are higher than the Organisation for Economic Co-operation and Development average.

At least 16.4% of SIDS and 3.4% of infant deaths not classified as SIDS are attributable to maternal alcohol use. Maternal alcohol-use disorder increases the risk of infant mortality through direct effects on the fetus and indirectly through environmental risk factors. (Read the full article)

Guidelines encourage pediatric health care providers to aid in identifying women with postpartum depression but not postpartum anxiety, yet the major life event of childbirth can be anxiety provoking for many women.

During the postpartum hospital stay, anxiety was far more common than depression among breastfeeding women. Anxiety remained more common for the 6 months after childbirth, and was associated with increased health care use and reduced breastfeeding duration, particularly among primiparous women. (Read the full article)

In Mexico, substantial declines in childhood diarrhea deaths have been documented since the introduction of the rotavirus vaccine in 2007. However, there is concern of lower vaccine effectiveness in less developed regions of Mexico with higher diarrhea-related mortality.

We documented significant and comparable declines across all 3 regions of Mexico with different levels of development, indicating equitable vaccine distribution to children with varying risk of mortality and reaffirming the beneficial effects of rotavirus vaccination against fatal diarrheal disease. (Read the full article)

Expectations are high that electronic health record–based clinical decision support and performance feedback will improve adherence to guidelines by delivering relevant and actionable information to clinicians. Few studies have evaluated these assertions or examined the combined effects of decision support and feedback.

Clinical decision support customized to a patient’s history and presentation and performance feedback are both effective for improving adherence to guidelines for otitis media. However, the combination of the 2 interventions is no better than either delivered alone. (Read the full article)

Accurately identifying ill hospitalized children with vital signs concerning for clinical deterioration is fundamental to inpatient pediatrics. Normal vital sign ranges for healthy children are useful for outpatient practice but have limited application to detecting deterioration in the hospital setting.

Percentile curves for heart and respiratory rate in hospitalized children were developed and validated. The distributions differed from existing reference ranges and early warning scores. They may be useful to identify vital signs deviating from ranges expected among hospitalized children. (Read the full article)

Acquired widespread pain syndromes of youth are prevalent, disabling, usually unexplained, and untreatable. Small-fiber polyneuropathy causes widespread pain and multisystem complaints in older adults. Some causes are treatable. Neurodiagnostic skin biopsy, autonomic function testing, and nerve biopsy permit objective diagnosis.

It identifies definite (in 59%) and probable (in 17%) small-fiber polyneuropathy among 41 young patients with otherwise-unexplained, childhood-onset widespread pain. It characterizes this new disease’s clinical features, diagnostic, and treatment options. Some cases appeared immune mediated and responded to immunomodulatory therapies. (Read the full article)

College students with asthma tend to have worse health outcomes than their peers without asthma. Consistent use of controller medication could improve outcomes for these students, but a predictive model of appropriate use of controller medication is needed.

This study adds risk tolerance and time preference to previously studied factors of nonadherence with control medication. These preferences have substantial impacts on use of controller medication and the potential success of asthma education programs. (Read the full article)

Although a growing body of literature suggests links between parental incarceration and negative child outcomes, research that uses representative US samples and focuses on health outcomes is limited.

Using a nationally representative US sample, we examined the association between parental incarceration and young adult mental and physical health outcomes. Results suggest childhood exposure to parental incarceration is associated with increased risk of long-term health problems. (Read the full article)

Although it is known that extremely preterm children are at increased risk for cognitive deficits, academic underachievement, and behavioral problems, the frequency and severity of these impairments may decline with advances in neonatal care.

Despite recent changes in obstetric and neonatal management of extremely preterm infants, the rate of neurobehavioral impairments at school age is still too high. (Read the full article)

Chlorhexidine cleansing of the cord can reduce mortality in high-risk settings. Time to separation may increase with topical applications of chlorhexidine; 1 previous community trial quantified this increase and did not measure whether caretakers perceived the delay.

Single and multiple cleansing of the umbilical cord increases time to separation by ~50%, or an average of 2 to 2.5 days. Caretakers were able to detect this difference and expressed dissatisfaction, while still accepting the intervention. (Read the full article)

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

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

In the only previous cross-sectional study, the quality of pediatric guidelines was rated low on the AGREE-II (Appraisal of Guidelines for Research and Evaluation II) scale. The levels of evidence used in pediatric clinical practice guidelines have never been described.

American Academy of Pediatrics guidelines score low on the AGREE-II scale. Approximately one-quarter of recommendations are based on expert opinion or no reference. These findings support the adoption of standards for guideline development and research targeted toward unsupported recommendations. (Read the full article)

Universal hepatitis B virus (HBV) vaccination is a cost-effective strategy to control HBV infection. Giving hepatitis B immunoglobulin to neonates of HBV carrier mothers additionally reduces transmission but is not widely used because of its expense and infrastructure requirements.

Maternal screening for hepatitis B surface antigen and hepatitis B immunoglobulin treatment of neonates of hepatitis B virus carrier mothers could be a cost-effective addition to universal vaccination in settings in which health infrastructure can support such an intervention. (Read the full article)

The etiology of congenital heart defects (CHDs) is largely unknown. A few studies have suggested that maternal emotional stress around the time of conception may be related to the occurrence of CHDs.

Using a large registry-based data source from Denmark, we found that prenatal exposure to maternal bereavement, as a marker of severe stress exposure, may increase the prevalence of CHDs in offspring. (Read the full article)

Clinic-based weight control programs for pediatric obesity are time and personnel intensive and not accessible to a large proportion of the population.

This is the first study to reveal the efficacy of a low-intensity, 5-month, guided self-help treatment of childhood obesity with effects on the target child’s weight immediately posttreatment and 6 months later. (Read the full article)

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

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

Infant and neonatal mortality rates in the United States decreased markedly during the twentieth century but have not decreased notably during recent years. There has been an increase in preterm and low birth weight births in recent years.

The lack of decrease in infant and neonatal mortality rates in recent years is due in large part to the increasing proportion of preterm and low birth weight infants, particularly infants <500 g. (Read the full article)

Rates of screen media use have risen in parallel with rates of obesity among young people. Identifying the specific characteristics of media use that are associated with obesity can help elucidate the explanatory processes and inform effective interventions.

This study examines the associations between BMI and characteristics of media use including the type of device, duration of use, and attention to the medium. The more that participants paid primary attention to television, the higher their BMI. (Read the full article)

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

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

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

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

At least half of the achievement gap for low-income, minority children is present at kindergarten entry; however, there are no population-level early childhood interventions that effectively engage and support families and teachers to ameliorate the impact of adversity on achievement.

This study evaluated ParentCorps, a family-centered, school-based intervention to promote self-regulation and learning for all children entering school in disadvantaged, urban neighborhoods. ParentCorps results in higher kindergarten achievement among low-income, minority children. (Read the full article)