Prone sleep, bed-sharing, maternal smoking during pregnancy, and prematurity increase the risk of sudden infant death syndrome. The sudden infant death syndrome rate initially declined dramatically after the initiation of the US Back-to-Sleep campaign in 1994, but subsequently plateaued.

The risk profile has changed since the Back-to-Sleep campaign; the prevalence of simultaneous risks has remained consistent. Intrinsic and extrinsic risks provide unification into 1 underlying triple-risk model and insights into potential underlying mechanisms. (Read the full article)

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

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

Emergency contraception is a safe and effective method of pregnancy prevention after unprotected intercourse.

Pharmacies commonly communicate misinformation, both to adolescents and to physicians, concerning who is able to access emergency contraception and through what means. (Read the full article)

Febrile seizure risk 7 to 10 days after measles-mumps-rubella-varicella (MMRV) is double that of separate measles-mumps-rubella (MMR) and varicella vaccines among 1-year-olds. Whether MMRV or MMR and varicella affect febrile seizure risk among 4- to 6-year-olds has not been reported.

Using Vaccine Safety Datalink data, we examined risk for febrile seizures after measles-containing vaccines. This study provides reassurance that MMRV and separately administered MMR and varicella were not associated with increased risk of febrile seizures among 4- to 6-year-olds. (Read the full article)

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

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

Nearly one-third of all US children are overweight or obese, with even higher prevalence among Mexican American children. Overweight and obesity increase systemic inflammation, contributing to increased risk for chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease.

Obese Mexican American children had concurrent alterations in both inflammatory markers and traditional disease risk markers, relative to healthy weight children. Our results provide evidence partially explaining the health disparity for disease in Mexican American children who are overweight/obese. (Read the full article)

Autism is widely considered a heterogeneous disorder in terms of etiology and phenotype. Although autism is usually a lifelong disorder, little is known about the rate or timing of how children develop regarding their communication and social functioning.

Utilizing annual evaluations for a large population of children with autism, we describe the 6 most common trajectories from diagnosis through age 14 years. Trajectories revealed considerable variation, and high socioeconomic status children were more likely to experience rapid improvement. (Read the full article)

Studies have found that the degree of detail with which palliative care is described and the order in which options are presented can affect end-of-life decisions. None of these studies, though, involved decisions regarding very premature infants.

Unlike other end-of-life decisions, those regarding extremely premature infants are influenced neither by the degree of detail nor order of presentation of management options. Deep-seated values embodied in the reasons given for these choices suggest why they are so robust. (Read the full article)

Some but not all randomized trials have shown effects of probiotics on incidence and duration of diarrhea and respiratory tract infections among children in developing countries. Calcium improves resistance to intestinal infections in adults, but efficacy in children is unknown.

Lactobacillus reuteri DSM17938 may prevent diarrhea, especially in children with lower nutritional status. Regular calcium milk, alone or with Lactobacillus casei CRL431, did not reduce diarrhea. None of the interventions affected respiratory tract infections in these Indonesian children. (Read the full article)

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

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

Although all residents progressively assume responsibility for clinical skills under the teaching and supervision of attending physicians, senior residents also assume responsibility for teaching and supervising. This leads to a dynamic negotiation of responsibilities, particularly on clinical work rounds.

A better understanding of how attending physicians and senior residents negotiate shared responsibilities for teaching and supervising, and the context in which this negotiation occurs, may clarify assumptions and set expectations for resident training. (Read the full article)

Trisomy 13 and trisomy 18, common chromosomal abnormalities, are generally considered fatal within the first year after birth, although some children live longer. Little is known, however, about the inpatient medical courses of these infants and children.

Evaluation of nationally representative hospitalization data demonstrates that a significant number of children with trisomy 13 and trisomy 18 live beyond 1 year of age and that the care they receive includes both medical and surgical treatments. (Read the full article)

During prenatal counseling for prematurity, information is provided to expectant parents to empower them to participate in the medical-care decision-making regarding their child. However, numerous studies have shown that providing information effectively during preterm labor is challenging.

The current study provides evidence that effectiveness of counseling can be improved by providing written information to parents before the face-to-face verbal counseling. Appropriately presented, detailed information improves knowledge and decreases maternal anxiety. (Read the full article)

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

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

High or low lymphocyte counts at birth have been reported as a marker for subsequent intraventricular hemorrhage, retinopathy of prematurity, and periventricular leukomalacia. However, this conclusion is questionable because reference ranges for lymphocyte counts have not been constructed by using large numbers of neonates.

This study provides reference ranges for lymphocytes of neonates. A high count at birth is associated with early onset sepsis and IVH and a low count with early onset sepsis, IVH, and retinopathy of prematurity. Among neonates with birth asphyxia, a low count identifies a high risk for death. (Read the full article)

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

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

Rural Alaska children have high rates of hospitalization with lower respiratory tract infections from a variety of pathogens. Past studies of risk factors for respiratory syncytial virus infection associated medically high-risk status, household crowding, and infant feeding practices with hospitalization.

This study reveals the importance of medically high-risk status and infant feeding practices as important factors in respiratory hospitalization. In addition, we identified woodstove use and the absence of 2 or more sinks in household as risk factors for hospitalization. (Read the full article)

Cross-sectional imaging can reduce the negative appendectomy rate (NAR) in children being evaluated for suspected appendicitis; however, the ability of diagnostic imaging to decrease NAR may vary by age and gender.

Cross-sectional imaging leads to a significant reduction in NAR for children younger than 5 years and girls older than 10 years. For boys older than 5 years being evaluated for uncomplicated appendicitis, advanced imaging appears to have limited value. (Read the full article)

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

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

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

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

Pain during routine infant immunization causes parental anxiety. Oral sucrose solutions are effective pain-reduction strategies. Few studies have measured a combined strategy of a physical intervention along with sucrose to decrease the infant’s pain response.

We demonstrate that a physical, nonpharmacological intervention called the 5 S’s (swaddling, side/stomach position, shushing, swinging, and sucking) provides significant pain reduction with or without sucrose during routine 2- and 4-month vaccinations. (Read the full article)

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

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

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

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

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

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

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

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

Some studies demonstrate that adolescents have different perinatal risks and outcomes than nonadolescents. Few studies have explored the maternity experiences or practices of adolescents that may underlie these differences, or compared these with nonadolescents by using a nationally representative sample.

Adolescents and young adults were more likely to experience physical abuse, late prenatal care initiation, poor prenatal health behaviors, lower breastfeeding initiation and duration rates, postpartum depression, and lower folic acid supplementation than adult women. (Read the full article)

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

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

Kindergarten entry vaccination requirements are associated with higher coverage for early childhood vaccines.

Middle school entry vaccination requirements may also be associated with higher coverage for adolescent vaccines, whereas education-only requirements appear not to have an impact at this time. (Read the full article)

Recent systematic reviews revealed that educational dietary interventions were effective in improving nutritional status and food consumption in the first year after birth. We are not aware, however, of studies in developing countries that have evaluated their long-term effectiveness.

This randomized trial revealed that, in a low-income population, the delivery of home-based maternal counseling focusing on breastfeeding and complementary feeding during the first year of children’s lives significantly improved the lipid profile at 7 to 8 years old. (Read the full article)

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

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

Assessing for adequacy of supervision in the clinical setting is challenging and may result in significant variability in care. Clinicians must quickly decide if a child and family necessitate direct counseling, further intervention, or require reporting to state agencies.

This study identified the most important characteristics for the evaluation of the adequacy of supervision of a young child. A standardized scale using these characteristics may result in an efficient means to reduce variability in care. (Read the full article)

Rates of coverage for recommended vaccinations in adolescents are substantially lower than Healthy People 2010 goals. Reminder/recall is an evidence-based strategy that is proven to increase immunization rates in both adults and young children.

This study shows that reminder/recall is effective in increasing adolescent immunization rates. Practices may also benefit financially from conducting reminder/recall in this age group if they are able to generate additional well visits and keep supply costs low. (Read the full article)

More than one-tenth pediatric patients use complementary and alternative medicines (CAM) for their medial conditions in the United States. Traditional Chinese medicine (TCM) is the most commonly used CAM in East Asia but large-scale epidemiologic studies are lacking.

In comparing TCM and non-TCM users among children in Taiwan, children’s age and parental TCM use were strongly associated with TCM use. Additionally, dyspepsia and allergic rhinitis were positively related to increasing TCM use. (Read the full article)

Information on infant safety after exposure to maternal antiretroviral regimens during pregnancy in international clinical trials is lacking. As antiretroviral drugs are released to populations in resource-limited settings through clinical trials, it becomes critical to collect pediatric outcome data.

The study demonstrates the feasibility of reporting infant outcomes following adult antiretroviral trials in developing countries, provides HIV-free infant survival and prospective growth data in association with maternal parameters, and details morbidity, mortality, and genetic defects following maternal antiretroviral exposure. (Read the full article)

Treatment of adolescent migraine remains a significant unmet medical need. In adults, the combination of sumatriptan and naproxen sodium has demonstrated superior efficacy, with similar tolerability, to its components in the acute treatment of migraine.

This study constitutes the first large-scale, placebo-controlled evidence for the acute relief of adolescent migraine pain and associated symptoms with an oral medication. (Read the full article)

Batteries, especially button batteries, are an important source of pediatric injury. Recent reports suggest that fatal and severe button battery ingestions are increasing.

An estimated 3289 battery-related ED visits occurred annually among US children <18 years of age, averaging 1 visit approximately every 3 hours. The number and rate of visits increased significantly during the 20-year study period, driven by increases during the last 8 study years. (Read the full article)

Some researchers have suggested that individuals with Down syndrome (DS) are protected from atherosclerotic disease; however, recent data from 2 large cohort studies of individuals with DS are significant for increased mortality from ischemic heart disease and cerebrovascular disease.

This study compares lipid profiles among children with DS and their siblings, highlighting the presence of a less favorable lipid profile in this high-risk population. (Read the full article)

Despite recommendations and a universal immunization program, a recent survey reported suboptimal influenza vaccination coverage in children aged 6 to 23 months in Ontario. Little is known about predictors of coverage in young children to target immunization strategies.

Full influenza vaccination coverage in young children in Ontario is <10% and declining since the 2006–2007 season. Medically high-risk children including low birth weight infants are more likely to be immunized, but maternal and health services characteristics remain important. (Read the full article)

Twin studies provide a natural experiment that can determine the extent of genetic and environmental influences on sleep behavior. Previous studies have indicated that genes contribute moderately to sleep.

In the largest pediatric study to date, we demonstrate that the shared environment strongly influences sleep behavior in infants, with no gender differences in the results. This research provides strong impetus to future work identifying the key modifiable environmental drivers. (Read the full article)

Previous research on injuries related to bottle, pacifier, and sippy cup use has largely focused on case reports of infant injuries or fatalities attributed to pacifiers or pacifier parts causing asphyxiation or to bottle warming causing burns.

This study is the first to use a nationally representative sample to investigate the range of injuries requiring emergency department visits associated with bottles, pacifiers, and sippy cups among children aged <3 years. (Read the full article)

Late-onset hypocalcemia is common in neonates, often presents with seizures or tetany, and is often attributed to transient hypoparathyroidism.

Late-onset hypocalcemia in neonates is often a sign of coexisting vitamin D deficiency and hypomagnesemia and is readily managed with therapy of limited duration, and neonates presenting with tetany or seizures due to hypocalcemia are unlikely to benefit from neuroimaging studies. (Read the full article)

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

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

Most acute wheezing episodes in preschool children are associated with rhinovirus, which decreases extracellular adenosine triphosphate levels, leading to airway surface liquid dehydration and submucosal edema, which cause failure of mucus clearance. These children respond poorly to available treatments.

Hypertonic saline inhalation, a pro–airway surface liquid hydration therapy, significantly decreases both length of stay by 33% (1 day) and the absolute risk of hospitalization by 30% in preschool children presenting with acute wheezing episode to the emergency department. (Read the full article)

The association of retinal hemorrhages (RHs) with abusive head trauma (AHT) is robust; 46% to 100% RHs are reported in AHT. There is potential selection bias with risk of circular reasoning because the majority of studies describing RH focus on AHT.

This is the first prospective observational study defining prevalence and distribution of RH in critically ill children excluding those with AHT. Severe multilayered RH were rare and observed in children with accidental fatal head injury, severe coagulopathy, severe sepsis, or a combination of these factors. (Read the full article)

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

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

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Our findings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to improve morbidity-free survival. (Read the full article)

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

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

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

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

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

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

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