The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure measurement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years. (Read the full article)

Expedited partner therapy (EPT) is an effective method of partner treatment of sexually transmitted infections but is not used frequently. There are limited data on provider knowledge, practices, and comfort with EPT use in adolescents.

California pediatric residents have knowledge gaps and discomfort providing EPT and presence of an adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Our findings support the need to improve EPT education in pediatric residencies. (Read the full article)

Electronic cigarettes are battery-powered devices that simulate tobacco cigarettes by vaporizing nicotine and other chemicals into an inhalable mist. They have gained popularity around the world, but little is known about their safety and addictive properties.

Among Polish youth, electronic cigarettes are the fourth most common source of nicotine after cigarettes, waterpipes, and snuff. For those aged between 15 and 24 years, ever use of an electronic cigarette was 20.9%, and 30-day use was 6.9%. (Read the full article)

Most studies on corticoid treatment of respiratory syncytial virus (RSV) respiratory diseases have revealed no beneficial effect. The mechanism by which RSV respiratory-infected patients are insensitive to the antiinflammatory effect of corticosteroids is unknown.

This study helps to understand how a respiratory syncytial viral infection may alter the normal antiinflammatory response to cortisol and the insensitivity to glucocorticoid treatment. The increase expression of β glucocorticoid receptor could be a marker of disease severity. (Read the full article)

Infants with hypoxic-ischemic encephalopathy suffer a high rate (>40%) of death or moderate to severe disability, even after therapeutic hypothermia. High-dose erythropoietin (Epo) reduces brain injury and improves neurologic function in animal models of neonatal hypoxic-ischemic brain injury.

Multiple doses of Epo (up to 2500 U/kg intravenously) given in conjunction with hypothermia are well tolerated in newborns with HIE. Epo doses of 1000 U/kg intravenously in cooled infants produce plasma concentrations that are neuroprotective in animal studies. (Read the full article)

Inflammatory bowel disease pathogenesis is incompletely understood. Previous pediatric studies suggested associations between antibiotic use and inflammatory bowel disease development but were limited by recall bias, lack of controls, incomplete antibiotic capture, or included exposures between symptom onset and diagnosis.

Our population-based cohort study suggests that certain childhood antibiotic exposures are associated with an increased risk of developing inflammatory bowel disease. Our findings have implications for understanding the condition’s pathogenesis and provide additional stimulus for reducing unnecessary childhood antibiotic use. (Read the full article)

Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care.

This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. (Read the full article)

Adult patients with neurocardiogenic syncope have shown high rates of depression. Patients with more severe depressive symptoms have higher rates of syncope recurrence. Psychiatric interventions improve quality of life and decrease syncope recurrence rates.

Children with neurocargiogenic syncope presented a 2.6-fold higher rate of clinically significant depressive symptoms compared to healthy controls. No recurrent syncope was noted during follow-up which along with improvement in family functioning predicted depressive symptoms improvement. (Read the full article)

National data from child protective services agencies have shown a 55% decrease in the incidence of substantiated cases of physical abuse from 1992 to 2009, but no study has tracked the occurrence of serious injuries due to physical abuse.

Using national data from hospitalized children, we found a statistically significant increase in the incidence of serious injuries due to physical abuse from 1997 to 2009. These results are in sharp contrast to data from child protective services. (Read the full article)

Implementing expanded vaccination recommendations has challenged primary care providers, who administer the majority of vaccines in the United States. School-located vaccination has been proposed as a means of increasing vaccination rates while reducing the burden on primary care providers.

This study assesses physicians’ support for their patients’ receipt of vaccines in school. Additionally, it compares physicians’ support for adolescent versus influenza vaccination and compares support by insurance status of their patient. (Read the full article)

There are limited data regarding the current status of the pediatric clinical trial enterprise.

Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible. (Read the full article)

The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.

The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting. (Read the full article)

Understanding human disease genomics requires large population-based studies. There is lack of standardization, as well as social and ethical concerns surrounding the consent process for pediatric participation in a biorepository.

The study identifies specific barriers to pediatric participation in biorepositories relative to adults, and proposes strategies to improve ethical and responsible participation of pediatric-aged patients in large-scale genomics and biorepository-driven research without significantly increasing research burden for affected families. (Read the full article)

Children investigated for alleged maltreatment have considerable physical, mental health (MH), developmental, and educational needs and often do not receive services to address these needs. The prevalence/correlates of MH services use in the current challenging financial environment is unknown.

This study demonstrates the importance of medical providers and schools for receipt of MH services for these children, but shows disparities in MH service use between white and nonwhite children. Unlike earlier findings, MH service use declined over the follow-up. (Read the full article)

Retinal hemorrhages occur in accidental and inflicted traumatic brain injury (ITBI) and some medical encephalopathies. Large numbers and peripherally located retinal hemorrhages are frequently cited as distinguishing features of ITBI in infants, but the predictive value has not been established.

This prospective retinal imaging study found that a diagnosis of ITBI in infants and children can be distinguished from other traumatic and nontraumatic causes by the presence of >25 dot-blot (intraretinal layer) hemorrhages (positive predictive value = 93%). (Read the full article)

Significant variation in congenital hypothyroidism screening operations/performance has been observed in the United States. The origin of this variation remains unknown, in part because of a lack of evaluation. Accordingly, debates persist about optimal screening operations including laboratory testing methods.

Four distinct screening protocols applied to Michigan resident infants are compared in detecting congenital hypothyroidism overall and specific to cases characterized by high initial thyrotropin concentrations thought to have a more severe form of the disease. (Read the full article)

Chromosomal microarray analysis offers a superior diagnostic yield over karyotyping for the evaluation of individuals with developmental disabilities. Many third-party payers, however, do not reimburse for microarray testing, citing a lack of evidence that patients benefit from testing.

This study demonstrates that microarray testing frequently identifies conditions that include features requiring specific medical follow-up and that referring physicians respond to abnormal test results with appropriate clinical actions. Microarray testing, therefore, provides direct benefits to patients. (Read the full article)

Healthy sleep is essential for supporting alertness and other key functional domains required for academic success. Research involving the impact of modest changes in sleep duration on children’s day-to-day behavior in school is limited.

This study shows that modest changes in sleep duration have significant impact on the behavior of typically developing children in school. Modest sleep extension resulted in detectable improvement in behavior, whereas modest sleep restriction had the opposite effect. (Read the full article)

Among middle-aged adults, genotype scores predict incident type 2 diabetes but do not improve prediction models based on clinical risk factors including family history and BMI. These clinical factors are more dynamic in adolescence, however.

A genotype score also predicts type 2 diabetes from adolescence over a mean 27 years of follow-up into adulthood but does not improve prediction models based on clinical risk factors assessed in adolescence. (Read the full article)

Oral health researchers and policy makers primarily use 4 national surveys to examine use of dental services among US children. Estimates from the surveys may vary, posing a challenge to population-based monitoring.

The authors of this study compared estimates of dental service use and delayed dental care obtained from 4 commonly used health surveys to appraise their utility for guiding pediatric oral health research and policy. (Read the full article)

The false-positive rate of newborn screening for classic congenital adrenal hyperplasia (CAH) remains high and has not been significantly improved by adjusting 17α-hydroxyprogesterone cutoff values for birth weight and/or gestational age. In response, 4 states have initiated second-tier steroid profile screening.

Under second-tier screening, the false-positive rate remains high, and classic CAH cases missed by screening (false-negatives) occur more frequently than reported. Physicians are cautioned that a negative screen does not necessarily rule out CAH. (Read the full article)

Several meta-analyses evaluating probiotics in preterm infants suggest a beneficial effect for the prevention of necrotizing enterocolitis and death, but less for nosocomial infection. Lactobacillus reuteri may reduce these outcomes because of its immunomodulation and bactericidal properties.

Although L reuteri did not appear to decrease the rate of death or nosocomial infection, the trends suggest a protective role consistent with the literature. Feeding intolerance and duration of hospitalization were significantly decreased in premature infants ≤1500 g. (Read the full article)

Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder of presumed autoimmune or autoinflammatory etiology predominantly affecting children. There are limited data on the characteristics and optimal treatment of CNO in the United States.

A US-based cohort of pediatric CNO patients revealed high rates of personal and familial autoimmunity. Coexisting autoimmunity was a risk factor for widespread involvement. Response to nonsteroidal antiinflammatory drugs was inferior to that with immunosuppressive and biologic agents. (Read the full article)

Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.

US boys appear to be developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys. (Read the full article)

The rising burden of allergy is most evident in infancy, indicating the importance of early exposures. Reduced vitamin D status in pregnancy has been associated with atopy and respiratory outcomes, but there is less information on other early allergic outcomes.

Cord blood 25-hydroxyvitamin D₃ concentrations <50 nmol/L were highly prevalent in an Australian population. Lower vitamin D levels were associated with increased risk of eczema at 12 months of age, whereas there was no association with sensitization or food allergy. (Read the full article)

Social and environmental risks related to substandard housing contribute to adverse health outcomes. Partnerships between the health care and legal systems can help families address such risks and help clinicians understand the legal context of health.

A medical-legal partnership colocated in a pediatric primary care setting identified and treated a large cluster of poor quality, substandard housing. Housing improvements were possible because of strong collaboration between clinicians, attorneys, community partners, and families. (Read the full article)

The past several decades have seen a dramatic increase in the costs of health care and the prevalence of childhood activity limitations. More families with children are experiencing financial burden related to the cost of health care and insurance.

We find significant inequities in the occurrence of delayed or forgone needed health care for families with children as a result of high health care–related financial burden and having a child with an activity limitation. (Read the full article)

Pediatric specialists are increasingly involved in prenatal care, particularly for congenital fetal conditions. Questions remain about pediatricians’ role in the management of maternal conditions that may affect postnatal health, and the attitudes of obstetric and pediatric specialists around such care.

Obstetric and pediatric specialists’ attitudes differ substantially regarding pediatricians’ role in providing consultation for maternal conditions that may affect a child’s health postnatally, and regarding whether court authorization may be appropriate when a woman refuses certain treatment recommendations. (Read the full article)

There is concern about the potential exploitation of children who are enrolled into clinical trials in developing and transition countries. Previous studies of globalization have only examined pediatric drug trials, and only 1 study has provided patient-level data by country.

The involvement of developing and transition countries depends on the product or indication under investigation and is greater for vaccines than for drugs or biologicals. Compared with our previous analysis, involvement of these countries in pediatric drug development has decreased. (Read the full article)

Interventions to reduce screen time in preschool-aged children are promising.

A screen time intervention in 3-year-old children implemented in the primary care setting did not reduce screen time or BMI. (Read the full article)

Hypothalamic-pituitary-adrenal axis suppression caused by inhaled corticosteroids is considered rare. Adrenal crisis has been described in children treated with high doses of inhaled fluticasone propionate. It was recommended that doses licensed for children should not be exceeded.

Biochemically confirmed hypothalamic-pituitary-adrenal axis dysfunction may occur in two-thirds of children treated with corticosteroids. Suppression may occur at low doses and especially with concomitant nasal steroids. Children with poor adherence or obesity may be less prone to adrenal crisis. (Read the full article)

Newborn screening is often seen as a fait accompli, even in programs that ostensibly proceed on the basis of informed choice and parental consent.

The study reports details of parental understanding, perceived ability to make an informed choice, and the availability of choice together with variables predictive of parental assessments of having made an informed choice. (Read the full article)

It has been suggested that maternal immune activation during pregnancy is associated with cardinal behaviors of autism in the offspring. Epidemiologic studies have yielded conflicting results concerning the association between any infection during pregnancy and the development of autism.

This population-based cohort study investigated the association between specific common infectious diseases, febrile episodes, or use of antibiotics during pregnancy by using maternal population-based self-reported data. (Read the full article)

Previous studies have revealed misconceptions among pediatric patients, their families, and athletic coaches surrounding concussion. Little is known about pediatric primary care and emergency medicine providers’ attitudes and beliefs about diagnosis and management of this mild traumatic brain injury.

Although pediatric primary care and emergency medicine providers regularly care for concussion patients and value their role in management, they may not have adequate training or infrastructure to systematically diagnose and manage these patients. (Read the full article)

Information is limited on adoption of fully functional electronic health records (EHRs) in office-based pediatric practices, such as rates of adoption, barriers to adoption, and features that pediatricians choose.

A nationwide survey of members of the AAP in 2009 found that pediatric adoption of fully functional EHRs lags general adoption. Barriers include financial and productivity concerns, but pediatricians are also concerned about finding systems that meet their specific needs. (Read the full article)

Disparities in vaccination coverage between American Indian/Alaska Native and white children previously existed between 2001 and 2004 but were not present in 2005.

This study updates a previous study by analyzing data through 2010 and found that these gains have been maintained. (Read the full article)

With increasing survival rates, there is growing interest in long-term quality of life among patients with univentricular heart defects, and neurodevelopmental deficits play a major role in adverse outcome.

Although median cognitive performance was within normal limits, major neurodevelopmental impairment was found in one-fourth, and minor neurologic dysfunction in almost half of patients. Brain MRI showed mostly ischemic findings of different degrees in the majority of patients. (Read the full article)

Doxorubicin therapy, effective against many malignancies, is limited by cardiotoxicity. Continuous-infusion doxorubicin, compared with bolus-infusion, reduces early cardiotoxicity in adults. Its effectiveness in reducing late cardiotoxicity in children remains uncertain.

This multicenter randomized trial assessed whether continuous-infusion of doxorubicin in pediatric patients provides long-term cardioprotection or improvement in event-free survival over bolus-infusion in acute lymphoblastic leukemia. Continuous-infusion of doxorubicin provided no cardioprotection or improvement in event-free survival. (Read the full article)

The impact of relative age at school entry on academic progress and the risk of being diagnosed with ADHD remains controversial. Stimulants are widely used as a therapeutic option for ADHD in the United States and increasingly in Europe.

Relative age among classmates affects academic performance among boys and girls into puberty, as well as children’s risk of being prescribed stimulants for ADHD. This should be taken into account when evaluating children’s performance and behavior in school to prevent unnecessary stimulant prescribing. (Read the full article)

Adolescents have high placebo response rates in depression treatment trials. Screening for depression will likely detect youth with a broad range of symptom severity, including some who would benefit from watchful waiting but might not require active treatment.

The strongest predictors of symptom persistence are depressive symptom severity at presentation and continued symptoms on repeat screening 6 weeks later. These results provide important information for the development of postscreening management protocols in the primary care setting. (Read the full article)

Osteopathy of prematurity continues to occur in preterm infants. Osteopathy of prematurity can cause rib fractures in ex-preterm infants.

Rib fractures in ex-preterm infants are often posterior and multiple. Posterior rib fractures may not be diagnostic of nonaccidental injury in ex-preterm infants. (Read the full article)

Some children with gastroenteritis fail to respond to oral rehydration. Subsequent interventions are dictated by regional preference. In North America, nasogastric rehydration is rarely administered. Caregiver and health care providers’ perspectives regarding its use have not been described previously.

Both caregivers and health care providers would select intravenous rehydration instead of nasogastric rehydration when oral rehydration fails. Greater knowledge mobilization efforts will be required for nasogastric rehydration to be adopted into clinical practice. (Read the full article)

Children with medical complexity are high users of acute health care, but little is known about their service use across the continuum of care services and in the context of overall health care expenditures.

Although accounting for <1% of the child population, children with medical complexity use almost one-third of all pediatric health care expenditures and make multiple transitions across providers and health care settings. (Read the full article)

Foreign-born children and adolescents in the United States experience higher tuberculosis (TB) morbidity rates than US-born children and adolescents. Pediatric risk assessment should account for country of birth, contact with a known TB case, or travel to TB-endemic countries.

Our study reports national data on parental/guardian countries of origin and international residence of pediatric patients with TB. Two-thirds of US-born children with TB have international family connections, and many have lived in countries with increased risk for TB acquisition. (Read the full article)

High doses of radiation have been linked to cancer induction in irradiated populations such as atomic bomb survivors. Medical imaging directs significant radiation doses to human tissues. Epidemiological studies have demonstrated that children are more sensitive to radiation than adults.

The link between cancer induction from moderate radiation doses such as diagnostic imaging is controversial. This study uses Food and Drug Administration–accepted formulas to calculate theoretical risk of breast cancer induction in female pediatric trauma patients receiving diagnostic imaging of the thoracic spine. (Read the full article)

A previous study of inflatable bouncer–related fractures has shown that upper extremity fractures are most common, and many fractures are caused by collisions; however, no study has examined nonfracture injuries or used nationally representative data to investigate inflatable bouncer–related injuries.

This is the first study to use nationally representative data to calculate national injury rates, assess risk factors, and examine trends for pediatric inflatable bouncer–related injuries treated in US emergency departments over a 21-year period (1990–2010). (Read the full article)

Delayed meconium passage impairs gastrointestinal function in premature infants. No intervention has been identified that accelerates meconium passage sufficiently. Gastrografin is an osmotic contrast agent used for radiologic examination of the bowel or for conservative treatment of uncomplicated meconium ileus.

Gastrografin did not accelerate complete meconium evacuation but stimulated gastrointestinal motility in a randomized, placebo-controlled trial in premature infants. Application shortened the time to full enteral feedings and hospital stay but was associated with necrotizing enterocolitis as a possible adverse event. (Read the full article)

Pediatric tuberculosis is significant for public health professionals because it is an indicator of the recent transmission of tuberculosis in the community. Data on incidence and clinical features of pediatric tuberculosis from China are scarce.

We conducted this study to describe the patient characteristics, clinical–epidemiological profile, and treatment outcomes for pediatric tuberculosis in a referral hospital setting in China. (Read the full article)

Physical inactivity is one of the major modifiable factors contributing to the growing national epidemic of childhood obesity. There is lack of literature on pedometer-determined physical activity (PA) during the school day in US minority kindergarten and first-grade students.

This is the first study to assess school-day PA in US urban minority kindergarten and first-grade students. Higher grade level, participation in physical education class, and outdoor recess were found to be independent predictors of PA. (Read the full article)

Adolescent physical fighting is an important public health concern with known social origins. However, existing international studies of adolescent fighting provide little evidence about its prevalence, trends over time, or possible socioeconomic determinants.

We studied frequent physical fighting among 494 874 adolescents in 30 countries over an 8-year period. Physical fighting declined in most countries. National measures of absolute wealth but not socioeconomic inequalities related to risk of frequent physical fighting. (Read the full article)