Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.

This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings. (Read the full article)

The gap between organ availability and need continues to grow, and infants are among the most vulnerable candidates on the wait-list. The scarcity of donor organs has led the transplant community to look for alternative donor sources.

Children are receiving more grafts from pediatric donors, but they also continue to receive adult donor grafts. Donation after circulatory determination of death increases organ availability. Allocation changes have also helped increase pediatric transplantation and decrease wait-list deaths. (Read the full article)

Universal oxygen saturation screening by pulse oximetry is now recommended for early detection of critical congenital heart disease. The distribution of saturations in asymptomatic newborns in a large population has not been described.

Our study is the largest to date to establish simultaneous pre- and postductal oxygen saturation nomograms in asymptomatic newborns at ~24 hours after birth. The mean postductal saturation is higher than preductal during this time. (Read the full article)

Abdominal pain is a frequent complaint in pediatric emergency departments, with a broad differential diagnosis. The impact of demographic and clinical characteristics of patients on the evaluation and management of these children is not well known.

The most common cause of abdominal pain is constipation, which rarely requires hospital admission. Demographic factors, in particular race, do not seem to affect evaluation and management. (Read the full article)

Sleep patterns of adult monozygotic twins are more similar than those of dizygotic twins, showing moderate heritability and little effects of environmental influences. There have been very few genetically informative studies of sleep in preschool children and results appear inconsistent.

From previous studies, we investigated daytime and nighttime continuous sleep duration longitudinally. This is the first time that the etiologies of daytime and nighttime continuous sleep duration trajectories were studied in early childhood. (Read the full article)

There are ethnic differences in lung function, with white people generally having higher values of FVC and FEV₁ than people of South Asian origin, whereas differences in forced expiratory flows are absent or less marked. The underlying reasons are unknown.

Lung function differences were not explained by cultural, socioeconomic, or perinatal factors, nor by environmental exposures or wheezing illness. This suggests that genetic factors are responsible, and supports the use of ethnicity-specific prediction equations for children of South Asian origin. (Read the full article)

Physicians have little knowledge of health care costs and charges. Studies suggest that education and awareness of hospital finances can decrease unnecessary utilization of resources. Little is known about pediatricians’ awareness of the economics of health care delivery in the inpatient setting.

Both general pediatric attending physicians and trainees acknowledged a limited understanding of hospital finances, and they demonstrated a lack of awareness of costs, charges, and reimbursements for inpatient care. (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)

Preterm neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in infants in developed countries.

For preterm infants born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. (Read the full article)

Parent or provider reluctance to immunize infants during sick visits is a common reason why infants fall behind on the recommended schedule. One previous study suggested that immunizations at sick visits discouraged parents from making up missed well-baby visits.

Delaying immunizations at sick visits can lower immunization rates without improving rates of well-baby visits. Many infants will not return to makeup well-baby visits missed because of a sick visit, regardless of whether immunizations were delayed or given. (Read the full article)

Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications.

Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, β-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. (Read the full article)

Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children >12 months of age.

The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up. (Read the full article)

The incidence of permanent hearing loss doubles between birth and school age. Otoacoustic emissions screening has been used successfully in early childhood educational settings to identify children with losses not found through newborn screening.

Using otoacoustic emissions to screen the hearing of young children during routine health care visits is feasible and can lead to the identification of permanent hearing loss overlooked by providers relying solely on subjective methods. (Read the full article)

Atherosclerotic cardiovascular diseases are rooted in childhood. Vascular intima-media thickness (IMT) and elasticity are early surrogate markers of atherosclerosis. In adults, cardiorespiratory fitness is associated with enhanced arterial elasticity and decreased IMT.

Fitness was favorably associated with aortic IMT and elasticity in adolescents. The association was independent of several cardiometabolic risk factors. In fit adolescents, the increase in IMT during the preceding 6 years was smaller compared with low-fit peers. (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)

About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.

In this large randomized controlled trial, anticipatory guidance on the "when, what, and how" of complementary feeding was associated with increased maternal "protective" feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance. (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)

Health care professionals face problems managing obesity and often fail to follow guidelines for its management in practice. Only a few single-country reports are available describing delivery of primary care to children with obesity.

Nearly all primary pediatric care providers from 4 European countries recognize the importance of obesity in pediatric practice, but only half use BMI clinically, and many lack the confidence and the infrastructure needed for providing care to patients with obesity. (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)

Uric acid (UA) is associated with hypertension in children, after body weight adjustment. Whether the whole spectrum of variables, such as visceral adiposity, insulin resistance, puberty, and renal function, influence the relationship between UA and blood pressure is unknown.

In a cohort of children at relatively high cardiovascular risk, the association between UA and blood pressure levels is independent of several well-known factors implicated in the development of hypertension, such as insulin resistance, pubertal status, and renal function. (Read the full article)

Wrapping very preterm newborns in polyethylene bags in the delivery room reduces hypothermia on admission to the NICU, but many infants remain cold despite their use. Placing polyethylene-wrapped infants on exothermic mattresses may reduce hypothermia but increase hyperthermia.

Placing polyethylene-wrapped very preterm infants on exothermic mattresses in the delivery room results in more infants with abnormal temperature and more hyperthermia on admission to the NICU. (Read the full article)

Racial and ethnic differences exist in age at diagnosis and early access to mental and behavioral health services among children with autism spectrum disorders (ASDs). ASDs are also associated with increased rates of other medical comorbidities that may require specialty care.

Significant racial and ethnic differences in use of specialty care and specialty procedures exist among children with documented ASD. (Read the full article)

Several studies have investigated the prevalence of chronic daily headache (CDH) and analyzed the risk factors for its persistence. However, the etiologic factors that lead to new-onset CDH remain unsettled in adolescents.

This study was the first incidence study of CDH conducted in young adolescents. We reported the incidence rates and found that some risk factors for incident chronic migraine and chronic tension-type headache were different. (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)

Young adult smokers frequently encounter the health care system as parents coming in for their child’s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents.

This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice. (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)

Minority children are less likely than white children to be diagnosed and treated with attention-deficit/hyperactivity disorder. However, diagnosis patterns over time in early and middle childhood and whether confounding factors explain these disparities are not currently well understood.

Racial/ethnic disparities in attention-deficit/hyperactivity disorder diagnosis occur by kindergarten and continue until eighth grade. Racial/ethnic disparities among diagnosed children in medication use occur in both fifth and eighth grades. These disparities are not attributable to confounding factors. (Read the full article)

Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate all-terrain vehicles (ATVs) properly, their risk of injury is greater.

During 2001–2010 in the United States, ~361 000 children aged ≤15 years were injured while riding ATVs. The decline in the injury rate during 2005–2010 might be related to the economic recession and decreased sales of new ATVs. (Read the full article)

Child maltreatment is a serious and prevalent public health problem in the United States. Responsible for substantial morbidity and mortality, maltreatment affects children's physical and mental health.

Although many health impacts of child maltreatment have been documented, no claims-based study has quantified the impact of maltreatment on health service utilization and costs. This study presents systematic claims-based estimates of maltreatment impacts on utilization and costs for the Medicaid population. (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)

Children with chronic pain complaints seem to represent an increasing portion of general pediatric inpatient services. Few data exist, however, on the characteristics of this population, their length of stay, or the best approach to their evaluation and management.

This study defines the demographic, diagnostic, procedural, and episode of care characteristics for children admitted to the acute care setting with chronic pain syndromes. Admission rates are rising, lengths of stay are substantial, and comorbid diagnoses are common. (Read the full article)

Functional somatic symptoms (FSS) in children account for 10% to 15% of visits in medical services. Few studies have investigated the full range of pediatric FSS and factors linked to the medical help-seeking for young children with these symptoms.

More parental worries, higher symptom severity and impact, and previous contact to medical services are found among the children with FSS who seek medical consultation. Putative risk mechanisms include the early pattern of health care use and parental worries. (Read the full article)

Language barriers adversely affect health care access, utilization, outcomes, and patient safety. Trained formal interpreters can improve care quality and safety, but many patients and families with limited English proficiency do not receive appropriate language services during health care encounters.

Despite continued growth of the US population with limited English proficiency, federal language use standards, and enhanced education about appropriate use of language services, there has been only modest improvement over time in pediatricians’ use of language services. (Read the full article)

Prenatal diagnosis and clinical examination do not identify all infants with critical congenital heart defects before hospital discharge. To improve early critical congenital heart defect detection, New Jersey was the first state to implement legislatively mandated newborn pulse oximetry screening.

This report is the first to evaluate statewide pulse oximetry screening implementation. New Jersey had a high statewide screening rate and identified 3 infants with previously unsuspected critical congenital heart defects that otherwise might have resulted in significant morbidity and mortality. (Read the full article)

Among infants with birth weights of 501 to 1500 g born between 2000 and 2009, mortality and major morbidities among survivors declined.

Obstetrical and neonatal care practices for infants 501 to 1500 g changed significantly from 2000 and 2009, particularly decreased conventional ventilation and use of steroids for chronic lung disease and increased nasal continuous positive airway pressure and surfactant treatment after delivery. (Read the full article)

Pain in children with cerebral palsy is underrecognized and undertreated and negatively affects quality of life. Communication challenges and multiple pain etiologies complicate management. There is a wide range of pain prevalence reported in the literature (14% to 73%).

The impact of pain on activities in children with cerebral palsy across a wide age range and motor abilities is investigated. Physician-identified causes of pain are systematically assessed and reported. Concordance of physician and caregiver identification of pain is evaluated. (Read the full article)

Physical punishment is associated with a range of Axis I and II mental disorders in adulthood. More research is needed on the possible long-term relationship between physical punishment and physical health.

To our knowledge, this is the first nationally representative examination of harsh physical punishment and physical health. Harsh physical punishment in the absence of child maltreatment is associated with higher odds of cardiovascular disease (borderline significance), arthritis, and obesity. (Read the full article)

Several risk factors for both overweight and obesity in childhood are identifiable during infancy.

A simple risk algorithm can be used to quantify risk of overweight in children. It can be used to help identify at-risk infants in a clinical setting to facilitate targeted intervention. (Read the full article)

There is wide variation in testing and treatment of children hospitalized with pneumonia. Limited data are available on diagnostic testing patterns and the association of test utilization with disposition outcomes for children with pneumonia evaluated in the emergency department (ED).

Significant variation exists in testing for pediatric pneumonia. EDs that use more testing have higher hospitalization rates. However, ED revisit rates were not significantly different between high- and low-utilizing EDs, suggesting an opportunity to reduce testing without negatively affecting outcomes. (Read the full article)

Patients with hereditary angioedema (HAE) have recurrent episodes of painful swelling. Several new therapies to prevent and treat HAE attacks are approved by the Food and Drug Administration, but their safety and efficacy in children are largely unknown.

Ecallantide appears effective for treatment of HAE attacks in pediatric patients age 10 to 17 years with an acceptable safety profile. It represents a potential treatment option for adolescents with HAE. (Read the full article)

Diabetic ketoacidosis (DKA) is a short-term complication of type 1 diabetes and is a major cause of preventable hospitalization in children. Hospital resource utilization and readmission rates for DKA across the US are not known.

Readmission for DKA within a year of hospitalization is common, accounting for one-fifth of all DKA admissions. Resource use, hospital length of stay, and readmission rates vary widely across major US children’s hospitals, even after adjusting for hospital differences in patients. (Read the full article)

Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied.

Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. (Read the full article)

Critical congenital heart disease (CCHD) was recently added to the US Recommended Uniform Screening Panel for newborns.

Routine screening could cost an estimated additional $6.28 per newborn and $40 385 per life-year gained. The incremental cost of screening might be approximately $0.50 per newborn with reusable sensors. Future analysis of newborn screening programs may help refine these projections. (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)

Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. Inhaled nitric oxide given to reduce morbidity in very preterm infants does not reduce the prevalence of bronchopulmonary dysplasia and has uncertain effects on long-term outcome.

Inhaled nitric oxide (5 ppm) given early in the course of respiratory illness in infants born before 29 weeks of gestation is not associated with changes in developmental or respiratory outcomes at 2 years of age corrected for prematurity. (Read the full article)

Newborns with critical congenital heart disease (CCHD) are at risk for cardiovascular collapse or death if discharged from the birth hospital without a diagnosis. Newborn screening aims to identify CCHD missed in prenatal and postnatal examinations.

Birth hospital nursery level and CCHD type were found to be associated with late CCHD detection. Routine newborn screening could conceivably reduce differences in the frequency of late diagnosis between birth hospital facilities. (Read the full article)

Preterm and low birth weight infants are at increased risk of hospitalization due to rotavirus gastroenteritis, and rotavirus vaccine is immunogenic and well tolerated among these infants when provided at or after discharge from the NICU.

Many preterm infants with a birth weight of ≤1500 g are not eligible to receive rotavirus vaccination because they remain in the NICU beyond the upper age limit recommended for immunization. New strategies are needed. (Read the full article)