Obesity is a risk factor for failure to initiate breastfeeding, formula supplementation, and short breastfeeding duration. There is a need for interventions that can improve the breastfeeding outcomes of overweight and obese women.

Breastfeeding peer counseling targeting overweight/obese women did not affect exclusive breastfeeding rates or breastfeeding continuation beyond 2 weeks. However, the intervention was associated with improvements in early breastfeeding intensity and fewer infant hospitalizations in the first 6 months after birth. (Read the full article)

Most observational studies from Western populations suggest that blood pressure is positively associated with low birth weight and faster infant growth; however, it is unclear whether these associations are biologically based or contextually specific.

In a developed non-Western setting with relatively little socioeconomic patterning of size or growth, birth weight and infant growth had relatively limited impacts on early adolescent blood pressure, which was more strongly related to recent growth and current size. (Read the full article)

Cerebral edema (CE) occurs frequently during treatment of diabetic ketoacidosis (DKA) in children. Severe, life-threatening CE occurs rarely, but subclinical CE is common. Whether the rate of infusion of intravenous fluids influences the occurrence or severity of CE is unknown.

This study demonstrates that the rate of fluid infusion in children with DKA does not substantially affect MRI measures of CE. Studies assessing measures other than edema formation are necessary to determine whether fluid infusion rates influence DKA-related brain injury. (Read the full article)

Endotracheal intubation of newborn infants is a common procedure. Competency in this skill is mandatory for many pediatric training programs. The safety and benefits of using a stylet for intubating newborn infants are unknown.

Pediatric trainees are commonly unsuccessful at performing endotracheal intubation. Adverse events of using a stylet are uncommon. The use of a stylet does not increase success rates. (Read the full article)

There are a few longitudinal studies that suggest that attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with later psychiatric disorders, substance use disorders, and impaired work performance.

Adolescent ADHD is associated with a variety of internal and external stresses in adulthood. Consequently, it is essential to focus intervention efforts on adolescents with ADHD to prevent or alleviate adult difficulties in functioning. (Read the full article)

Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.

This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims. (Read the full article)

Low birth weight (LBW) infants (<2500 g) are at risk for cognitive and behavioral problems later in life. During infancy, they are also at risk for iron deficiency, which has been associated with impaired neurodevelopment in other high-risk groups.

Iron supplementation during the first 6 months of life to LBW infants reduces the risk of behavioral problems at 3.5 years. Mild iron deficiency in infancy may be an important, preventable contributor to behavioral problems in children born with LBW. (Read the full article)

The medical home likely plays a positive role in outpatient health outcomes. Asthma is a common and frequent reason for pediatric hospitalization. It is unknown whether having a quality medical home can prevent readmission in children hospitalized for asthma exacerbations.

Poor access to a medical home was associated with increased readmission for asthma, whereas other measured aspects of medical home were not. Children with private insurance and good access to care had the lowest rates of readmission within a year. (Read the full article)

Children with congenital heart disease (CHD) are at increased risk for poor growth. Several factors may play a role in poor growth, including feeding difficulties, increased caloric requirements, and the effects of cardiac lesions on growth regulation.

In children with CHD, impaired growth as measured by weight, length, and head circumference occurs simultaneously rather than sequentially, supporting the theory that altered growth regulation likely plays an important role in the poor growth of children with CHD. (Read the full article)

Sugar-sweetened beverage (SSB) consumption is associated with childhood obesity risk. Because dietary salt intake is a determinant of fluid consumption in adults, a high-salt diet may predict greater consumption of SSBs and therefore increase obesity risk.

In Australian children, the amount of salt consumed was positively associated with fluid consumption, and predicted the amount of SSB consumed. In addition, SSB consumption was associated with obesity risk, indicating a potential link between salt intake and childhood obesity. (Read the full article)

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)

There is evidence that Kingella kingae, the major bacterial cause of osteoarticular infection in children <4 years of age, first colonizes the oropharynx before penetrating the bloodstream and invading distant organs. Diagnosis remains challenging because clinical findings at admission may be normal.

Our study demonstrated for the first time that a simple technique of detecting of K kingae DNA in the oropharynx can provide strong evidence that this microorganism is responsible for the OAI, or even stronger evidence that it is not. (Read the full article)

Cow’s milk consumption has opposite effects on vitamin D and iron levels in children; however, the amount of cow’s milk intake required for sufficient stores of vitamin D and iron is poorly understood, and existing guidelines on consumption are unclear.

Two cups of cow’s milk per day is sufficient to maintain healthy vitamin D and iron stores for most children. Wintertime vitamin D supplementation appears particularly important among children with darker skin pigmentation. (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)

The eating of non–nutrient dense snack foods is considered a major factor contributing to childhood obesity. Parents are often ineffective at encouraging healthier snacking habits.

Children consumed fewer calories when snacking on nutrient-rich cheese and vegetables compared with when they were served potato chips. (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)

Adequate vitamin D is essential for skeletal health in developing children. Although excess body weight is associated with risk of vitamin D deficiency, the national prevalence of vitamin D deficiency in overweight and obese children is unknown.

Vitamin D deficiency is highly prevalent in overweight and obese children, and severely obese and minority children are disproportionately affected. There are many modifiable factors associated with vitamin D deficiency in overweight and obese children. (Read the full article)

Lifestyle and vulnerability associated with food allergy might predispose affected children to being bullied. Our previous parent survey identified high rates of bullying in this population, but child reports and emotional impact were not assessed.

Bullying was common, often involving threats with food. Bullied food-allergic children, compared with nonbullied, report higher anxiety and lower quality of life. Parental awareness of bullying (~50% of cases) was associated with better social and emotional functioning in the child. (Read the full article)

Childhood headache is a common medical condition and can negatively impact a child’s social and academic life in several ways. Early and accurate diagnoses of headache syndromes, including migraine, are essential to appropriate treatment and outcome for affected youth.

The Diagnostic Interview of Headache Syndromes–Child Version is a new tool for the assessment of pediatric migraine that can enhance the standardization of collection of diagnostic criteria in both clinical and community settings, leading to better recognition and treatment of this condition. (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)

A reduced nephron number is associated with glomerular hyperfiltration, resulting in renal injury such as hypertension, proteinuria, and chronic kidney disease. Patients with a solitary functioning kidney have an increased risk of dialysis in early adulthood.

This study demonstrates that a subset of children with a solitary functioning kidney progress toward renal injury during childhood. Risk factors for renal injury are ipsilateral anomalies of the kidney and urinary tract and small renal length. (Read the full article)

Effective interventions are still elusive for the large numbers of children affected by overweight/obesity. The value of targeting physical activity (PA) remains unclear because its predictive relationship with improved BMI is still surprisingly poorly quantified.

In overweight and mildly obese children presenting to primary care, 3-year changes in PA (especially the moderate-vigorous component) predicted BMI outcomes. However, the effect was small, possibly explaining the disappointing BMI outcomes of brief primary care interventions targeting PA. (Read the full article)

Heuristics are decision-making aids or shortcuts that ease the task of making a wide variety of decisions in diverse contexts. Little is known about the heuristics that parents of children with serious illness use when confronting difficult decisions.

Parents of children with life-threatening illnesses use several different types of heuristics, explicitly, in making sense of complex situations, making decisions, and communicating these decisions to others. Better understanding of these heuristics may improve communication and decision support. (Read the full article)

Children exposed to second-hand smoke have high rates of hospitalization for respiratory illness. These visits represent a "teachable moment" when parental smokers can be motivated to quit. However, pediatric health care practitioners receive little training in tobacco cessation.

The Web-Based Respiratory Education About Tobacco and Health online training program was effective at increasing the provision of an effective tobacco cessation intervention by pediatric hospital-based respiratory therapists, registered nurses, and nurse practitioners to adult smokers. (Read the full article)

Routine screening of potentially abused children with hepatic transaminases has been recommended, using a threshold of 80 IU/L to determine the need for further testing, but practice is variable, and this threshold has not been validated.

This study identified abdominal injury in a significant fraction of potentially abused children with transaminases >80 IU/L. (Read the full article)

Birth asphyxia, or failure to initiate or sustain spontaneous breathing at birth, contributes to ~27% to 30% of neonatal deaths in resource-limited countries, including Tanzania. Without change, these countries will fail to meet Millennium Development Goal 4 targets by 2015.

The Helping Babies Breathe program was implemented in 8 hospitals in Tanzania in 2009. It has been associated with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years. (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)

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)

Among youth with asthma, tobacco smoke exposure causes increased asthma morbidity. Little is known about changes over time in tobacco smoke exposure among youth with asthma in a national sample.

Our analysis reveals a decrease in environmental tobacco smoke exposure among children and adolescents with current asthma in the United States from 1988–1994 to 2005–2010, but a majority of youth with asthma remain exposed to environmental tobacco smoke. (Read the full article)

Follow-up skeletal surveys are conducted commonly in children with suspected physical abuse, despite limited evidence. Different guidelines recommend follow-up skeletal surveys in children with abnormal initial skeletal surveys or in cases with high risk.

Across several centers, follow-up skeletal surveys revealed new information in >20% of cases and frequently affected the perceived likelihood of abuse, even in cases where the initial level of concern for abuse was moderate. (Read the full article)

The rise in type 2 diabetes in youth is a major public health concern thought to be partially due to decreasing activity levels and increasing obesity. The role of sedentary time as a possible contributor also needs to be examined.

Measured objectively, obese youth, with or without type 2 diabetes, spend little time in moderate to vigorous physical activity. Those with type 2 diabetes, however, were significantly more sedentary than their obese counterparts, identifying an important area for future intervention efforts. (Read the full article)

Health care transition services assist youth with special health care needs (YSHCN) in transitioning to adult care without gaps in services or health insurance coverage. Less than half of YSHCN receive anticipatory assistance in this transition; receipt of these services for youth with autism spectrum disorder is unknown.

Youth with autism spectrum disorder receive transition services half as often as youth with special health care needs. Quality of health care is associated with increased receipt of health care transition services. Presence of comorbid conditions decreased receipt of transition services. (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)

Most studies focus on health of foster children or local samples of young children. One previous study examined a national cohort longitudinally but did not address the full age group or range of conditions at the time of initial investigation.

Using 2 approaches to assess children (aged 0–17.5 years) who have chronic health conditions, we found that regardless of placement, investigated children had much higher rates of these conditions than the general population at the time of initial assessment. (Read the full article)

Many studies have identified an association between television viewing and antisocial behavior, although very few have been able to demonstrate a cause-and-effect sequence. The issue of whether excessive television viewing contributes to antisocial behavior remains controversial.

Excessive television viewing during childhood and adolescence was associated with objective and subjective measures of antisocial behavior in adulthood. These associations were not explained by preexisting antisocial tendencies or other potential confounders. Excessive television appears to have long-term psychosocial consequences. (Read the full article)

Trigger scores and early warning systems provide an objective measure of a patient’s condition, allowing earlier recognition of severe illness and adaptation of care. Such scores are established in adult and pediatric populations but remain unevaluated and rarely used in neonates.

This newly designed Neonatal Trigger Score provides an objective adjunct to multidisciplinary clinical assessment in detecting unwell neonates. It is more sensitive and specific than previously validated pediatric early warning system scores. (Read the full article)

UV radiation exposure in tanning beds is associated with an increased risk of skin cancer. Because of the rising rate of melanoma, the World Health Organization recommends that persons <18 years of age not use tanning devices.

Despite scientific evidence to the contrary, tanning facilities in Missouri, a state without indoor-tanning regulations, often misinformed consumers regarding the risk of skin cancer and would allow children as young as 10 years old to use tanning devices. (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)

Failure to thrive (FTT) is a common and vexing pediatric problem. Evaluation has historically involved large batteries of tests, multiple consultations, radiologic studies, and prolonged hospital admissions, resulting in significant costs and inconsistent results.

Scheduled failure to thrive (FTT) admissions on weekends result in increased lengths of stay and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs. (Read the full article)

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. Studies among adults suggest that SNAP participation may be associated with suboptimal diets. Few studies have extensively examined these associations among children.

SNAP participation was not associated with childhood obesity. SNAP children consumed diets poorer in some aspects than nonparticipants, but intake of some micronutrients was higher. The diets of both groups of low-income children were far from meeting dietary guidelines. (Read the full article)

Pediatric training programs use simulation for procedural skills training. Research demonstrates student satisfaction with simulation training, improved confidence, and improved skills when retested on a simulator. Few studies, however, have investigated the clinical impact of simulation education.

This is the first multicenter, randomized trial to evaluate the impact of simulation-based mastery learning on clinical procedural performance in pediatrics. A single simulation-based training session was not sufficient to improve interns’ clinical procedural performance. (Read the full article)

Skin and soft tissue infections (SSTIs) are a common pediatric condition often requiring inpatient management. Several studies describe recent increases in hospitalizations due to SSTIs.

In addition to rising hospitalizations, analysis of pediatric SSTI resource utilization trends revealed a twofold increase in incisions and drainages over a 13-year period. A growing number of incisions and drainages were performed in younger children. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) has been viewed as a neurodevelopmental disorder, adversely affecting behavior and school performance, with studies suggesting increased risk for poor adult outcomes. However, no prospective studies have examined long-term outcomes of childhood ADHD in an epidemiologic sample.

Our epidemiologic study indicates that adults with childhood ADHD are at increased risk for death from suicide. ADHD persists into adulthood in 29.3% of childhood ADHD cases, and 56.9% have ≥1 psychiatric disorder other than ADHD. (Read the full article)

Children with sickle cell disease (SCD) have a higher basal metabolic rate, and have historically been underweight. In the general pediatric population, the average BMI percentile has been rising over the past 2 decades.

BMI percentiles for children with SCD in New England are higher than historically reported, mimicking the weight status in the general pediatric population. In children with SCD, higher hemoglobin levels increased the odds of being overweight and obese. (Read the full article)

Autism is a disorder that significantly affects language/communication skills, with many children not developing fluent language. The rate of spoken language acquisition after severe language delay and predictors of functional language, beyond comorbid intellectual disability, is less clear.

This study uses the largest sample to date to examine the relationship between key deficits associated with autism and attainment of phrase and/or fluent speech after a severe language delay, providing information to guide therapeutic targets and developmental expectations. (Read the full article)

Despite high coverage with acellular pertussis vaccine (DTaP), rates of pertussis have increased substantially in 7- to 10-year-olds in recent years. Duration of protection with 5 doses of DTaP may wane earlier than expected and is currently not well described.

This evaluation reports increasing risk of pertussis in the 6 years after receipt of the fifth DTaP dose, suggesting that waning of vaccine-induced immunity is occurring before the recommended adolescent booster dose at 11 to 12 years of age. (Read the full article)