Recent studies have shown that participating in the Supplemental Nutrition Assistance Program (SNAP) is associated with improved household food security. With the exception of 1 descriptive analysis, studies have not examined how SNAP affects children’s food security.

This article estimates the association between SNAP and children’s food security using the largest, most rigorous national study of food security to date. Given current proposals to reduce program size, this study underscores SNAP’s importance in affecting children’s well-being. (Read the full article)

Existing literature indicates relationships between BMI, physical activity, sleep patterns, eating behavior, and health-related quality of life in children and adolescents. However, many previous studies have used non–preference-based instruments, which are not suitable for application within economic evaluation.

The Child Health Utility 9D, a new preference-based health-related quality of life instrument for application in economic evaluation in children and adolescents, revealed stronger associations between utilities and sleep patterns or eating behavior than with BMI, physical activity, or sedentary behavior. (Read the full article)

After mild traumatic brain injury, most youth recover well. A minority of patients report persistent symptoms, which relate to both injury and noninjury factors. In adult studies, validity test performance is 1 noninjury factor that relates to persistent symptoms.

This is the first pediatric study to demonstrate that validity test failure is associated with increased symptoms after mild traumatic brain injury. The findings suggest that some symptoms conceptualized as injury-related "postconcussive" problems are better explained by exaggeration or feigning. (Read the full article)

Concussions in youth are a common injury evaluated in the emergency department (ED). Early recognition and active management of this mild traumatic brain injury are important to safe recovery. Tools to assess and manage concussion in the ED are lacking.

Acute Concussion Evaluation tools, modified for ED use, improved reported follow-up with primary care or concussion specialists and adherence to recommendations. Barriers to follow-up remain and the importance of ongoing outpatient management should be stressed. (Read the full article)

Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation.

Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. (Read the full article)

Mobile devices are ubiquitous in children’s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiver–child interactions, has not been studied.

In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction. (Read the full article)

Asthma is a clinical condition treated mostly at primary care community clinics. Epidemics of asthma exacerbation occur annually with return to school after summer vacation and have been reported in many countries, including Israel.

In 82 234 asthmatic children, unscheduled primary care physician visits and drug prescriptions for asthma exacerbations peaked in September after a summer trough, with a lesser peak in late autumn and fluctuations through the winter months. (Read the full article)

Individuals living in Mediterranean countries have historically had a lower risk of cardiovascular disease. Important changes in diet and lifestyle have taken place in these countries in recent years, and it is unknown how these changes might influence current cardiovascular health.

Fitness and fatness levels indicate that urban adolescents from southern Europe are less healthy than those from central northern Europe. The extent to which these differences might be explained by physical activity, diet, and genetics is analyzed and discussed in this article. (Read the full article)

Adolescents and young adults consume a significant amount of health care resources in our current medical system. With the Patient Protection and Affordable Care Act, a much larger number of previously uninsured young adults (aged ≥19) will be covered.

The Military Health System provides valuable information about the health utilization patterns of adolescents and young adults (aged 12–22) with universal insurance and excellent access to care. This information may help us understand the impact of new health care legislation. (Read the full article)

Approximately 50% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) at <7 years of age in the community do not meet criteria for ADHD over time. There is a need to examine predictors of diagnostic stability in young children with ADHD.

Predictors of diagnostic stability from early to middle childhood include child’s baseline externalizing and internalizing symptoms, parental history of psychopathology, and socioeconomic status. These predictors may guide treatment planning at the time of ADHD diagnosis. (Read the full article)

The pediatric mental health burden is substantial, with >4 million children meeting criteria for a mental health disorder. Mental health is a key priority for national pediatric inpatient quality measures, but little is known about admitted patients and their diagnoses.

Nationally, nearly 10% of hospitalizations in children >3 years are for primary mental health diagnoses. The most common and costly are depression, bipolar disorder, and psychosis. Fewer free-standing children’s hospitalizations (3%) were for mental health admissions, although diagnostic distributions were similar. (Read the full article)

Although expert consensus and previous literature document the importance of early feeding and activity behaviors and practices in preventing obesity and the risks of early rapid weight gain, few studies have rigorously assessed obesity-related behaviors by caregivers of infants.

This study demonstrates the high prevalence of behaviors thought to increase risk for obesity in a diverse, large sample of parent/2-month-old dyads and finds that many behaviors vary by race and ethnicity, suggesting the potential for culturally tailored interventions. (Read the full article)

Childhood attention-deficit/hyperactivity disorder has been associated with both childhood and adult obesity, whereas treatment with stimulants has been associated with delayed child growth. No longitudinal studies with details about dates of diagnosis, treatment, and duration of stimulant use have been published.

Using electronic health record data, this was the first study to evaluate the independent associations of attention-deficit/hyperactivity disorder diagnosis, stimulant treatment, age at first stimulant use, and duration of stimulant use on longitudinal BMI trajectories throughout childhood and adolescence. (Read the full article)

The period of transition from childhood to adulthood and the period immediately after transfer of care is a challenging time for young people with kidney failure.

Young patients with kidney failure cared for exclusively in adult-oriented facilities experience increased rates of avoidable hospitalizations during late adolescence and young adulthood. Avoidable hospitalizations increased among pediatric kidney failure patients during the years immediately after transfer to adult care. (Read the full article)

Initial studies in children and young adults have identified higher levels of anxiety and lower quality of life scores in patients with implantable cardioverter–defibrillators. Few studies are available looking at the same questions in young patients with pacemakers.

Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation rather than type of device. Patients with pacemakers have depression and anxiety but at lower rates. (Read the full article)

Physical activity is beneficial to health. Parents are crucial in shaping children’s behaviors, with active mothers appearing to have active children. Little is known about this association in preschool-aged children, or about factors influencing activity in mothers of young children.

Mother-child physical activity levels were positively associated and influenced by temporal and demographic factors. Maternal activity levels were low, and influences differ by activity intensity. Health promotion efforts to increase activity in mothers may also benefit their young children. (Read the full article)

Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prevalence of DKA at diagnosis was 25.5% in 2002–2003.

DKA in youth with type 1 diabetes remains a problem, with almost one-third presenting with DKA. Among youth with type 2 diabetes, DKA was less common and decreased by ~10% per year, suggesting improved detection or earlier diagnosis. (Read the full article)

Resistance exercise is known to have a robust effect on glycemic control and cardiometabolic health among children and adolescents, even in the absence of weight loss.

Normalized strength capacity is associated with lower cardiometabolic risk clustering in boys and girls, even after adjustment for cardiorespiratory fitness, level of physical activity, and BMI. (Read the full article)

Physical activity interventions aimed at improving body composition in childhood have had limited success and often targeted overweight children. Therefore, the efficacy of physical activity randomized controlled trials in improving body composition among children with varying adiposity levels remains unknown.

This randomized controlled trial demonstrated that a physical activity program designed to meet daily physical activity recommendations can improve cardiorespiratory fitness, decrease total fat mass, and prevent accumulation of central adiposity in a group of children with varying adiposity levels. (Read the full article)

The incidence of Kawasaki disease is increasing in many countries. The only reported Australian incidence (3.4/100 000 <5 years) is almost 20 years old and the current Australian epidemiology and outcomes are unknown.

We analyzed 30 years’ total population hospitalization data from Western Australia. Kawasaki disease incidence increased markedly from 1979 to 2009 and is currently 9.34/100 000 <5 years. The epidemiology and cardiovascular outcomes are similar to other predominantly European-Caucasian populations. (Read the full article)

Individuals with DiGeorge syndrome (DGS) have varying degrees of immunodeficiency. All are susceptible to vaccine-preventable infections with serious complications. Although live vaccines are generally contraindicated in this population, limited evidence suggests that they may be effective and safe for select individuals.

Many individuals with DGS received live vaccines despite having a known diagnosis. Adverse events following live immunizations were typically minor and self-limited, suggesting that live vaccines may be considered for patients with DGS who exhibit mild-to-moderate immunosuppression. (Read the full article)

Scabies is a frequent cause of consultation and has recently been classified as a neglected disease. The clinical presentation seems to be linked with age, although no specific study has aimed to delineate the clinical spectrum of scabies in infants and children.

Scabies in infants and children has distinct clinical features. This prospective observational study found that infants were more likely to have relapse, nodules, and to present involvement with extremities, face, and scalp, arguing for specific cares in this age group. (Read the full article)

Preterm infants have transiently lowered thyroid hormone levels during the early postnatal period. Past research suggests that low thyroid hormone levels are related to cognitive and developmental deficits in children born preterm.

Contrary to expectations, in this study of children born <30 weeks’ gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age. (Read the full article)

Left heart defects, such as bicuspid aortic valve, are heritable. Echocardiography screening has been recommended for first-degree relatives of patients with left heart defects. Such screening may allow timely recognition of complications such as progressive aortic dilation.

This study examines the utility and cost of echocardiography screening of siblings of patients with bicuspid aortic valve in clinical practice. Screening has high yield, and the cost compares favorably with those of other screening methods used in pediatrics. (Read the full article)

Maternal prepregnancy obesity is associated with an increased risk of neurodevelopmental disorders in children, but previous studies have not taken paternal obesity into account. This has precluded differentiation between the effects of intrauterine exposures and potential genetic associations.

Robust associations were demonstrated between paternal obesity and the risk of autistic disorder and Asperger disorder in children. This study is the first to implicate paternal obesity as a risk factor for autism, and replication is warranted. (Read the full article)

Rapid and reliable tools for the diagnosis of neonatal sepsis are still unavailable. No single biomarker studied has yielded conclusive results. Genome-wide expression profiles (GWEPs) have been successfully determined for the diagnosis of sepsis in pediatric and adult populations.

GWEPs are described for the first time in very low birth weight infants with proven bacterial sepsis. Our results suggest that GWEPs could be used for early discrimination of septic newborn versus nonseptic infants. (Read the full article)

One in 4 children with cerebral palsy (CP) have a behavioral disorder. Parenting interventions are an efficacious approach to treating behavioral disorders. There is a paucity of research on parenting interventions with families of children with CP.

This is the first study to demonstrate the efficacy of a parenting intervention in targeting behavioral problems in children with CP. Further, results suggest that Acceptance and Commitment Therapy delivers additive benefits above and beyond established parenting interventions. (Read the full article)

Existing data do not demonstrate a need for combination therapy after antimicrobial susceptibility data indicate adequate in vitro activity with β-lactam monotherapy. However, the role of empirical combination therapy for the treatment of Gram-negative bacteremia in children remains unsettled.

We conducted a retrospective, propensity-score matched study demonstrating no improvement in 10-day mortality of children who have Gram-negative bacteremia receiving empirical β-lactam and aminoglycoside combination therapy compared with β-lactam monotherapy, unless the bacteremic episode was attributable to a multidrug-resistant organism. (Read the full article)

Young children have multiple upper respiratory infections (URI) annually. Limited health literacy regarding URI can place families at risk for emergency department (ED) visits, inappropriate use of over-the-counter medications, and medication measurement errors.

Few educational interventions for URI have targeted groups with limited health literacy. Integrating an educational intervention into Early Head Start is a novel approach to increasing parental health literacy regarding URI and decreasing ED visits, with potential for wide dissemination. (Read the full article)

The use of electronic health record systems to measure adolescent health care quality requires an operational definition of sexual activity for measuring recommended health promotion activities such as Chlamydia screening and others related to reproductive health.

This study is the first to compare operational definitions of sexual activity by using information electronically abstracted from electronic health records of adolescent females. Our research supports the use of broader operational definitions of sexual activity for health quality measurement. (Read the full article)

There is growing understanding of the detrimental effect of paternal depression on children. The transition to fatherhood is a unique time for men. Identifying which fathers are at-risk and when will inform effective methods to help men and their families.

Nonresident fathers have the highest depression symptom scores, peaking before entering fatherhood. Although resident fathers’ scores decrease preceding entry into fatherhood, there is a significant increase from 0 to 5 years of their child’s life when key parent–infant attachment occurs. (Read the full article)

Inadequate sleep in childhood is associated with poor mental and physical health. Numerous cross-sectional studies reveal associations between television viewing and the presence of a bedroom TV and inadequate sleep in older children and adolescents, but longitudinal research is limited.

More TV viewing, and, among racial/ethnic minority children, bedroom TV, were associated with shorter sleep from infancy to midchildhood. These results raise the possibility that interventions to reduce TV could improve children’s sleep. (Read the full article)

Injuries in children and young adults commonly cause morbidity and mortality. Epilepsy is common among children. Injury risk may be greater among those with epilepsy, but there are few large, population-based studies, making it difficult to estimate risk.

Children and young adults with epilepsy are at a greater risk of medicinal poisonings, thermal injuries, and fractures than those without epilepsy. Young adults with epilepsy are at particularly high risk of medicinal poisonings. (Read the full article)

Several studies suggest that excessive media use in early childhood predicts poorer developmental outcomes. It has not been studied whether infants with self-regulation problems, who may be at higher developmental risk, develop excessive media use habits.

This study shows that infants and toddlers with self-regulation difficulties (ie, problems with self-soothing, sleep, emotional regulation, and attention) view more media at 2 years of age, independent of other important confounders. (Read the full article)

Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like selective serotonin reuptake inhibitors (SSRIs). Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear.

This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays. However, underlying depression and its genetic underpinnings may be a confounder. (Read the full article)

A national probability study based on time diaries for 2 days indicated that black and white adolescents get close to the recommended amount of sleep. Sleep should be measured by using multiple methods to get an accurate picture of adolescent sleep.

Based on actigraphy and daily diary assessments, healthy adolescents from a lower socioeconomic community got less than the recommended amount of sleep; black male students were likely to have short, fragmented sleep, which may play a role in their health risks. (Read the full article)

Home oxygen has been safely incorporated into emergency department management of bronchiolitis in certain populations. After discharge, a small proportion of patients (2.7%–6%) require subsequent admission. For patients managed successfully as outpatients, pediatricians report variable practice styles and comfort levels.

Our results define the clinical course and outpatient burden associated with discharge on home oxygen. By using an integrated health care system, we captured slightly higher rates (9.4%) of subsequent admission and found fever to be associated with this outcome. (Read the full article)

In the United States, given the high burden of disease, influenza vaccine is recommended for all children from age 6 months. The paucity of vaccine effectiveness data in children <2 years has led some to argue against routine vaccination in this age group.

This study reveals the effectiveness of trivalent influenza vaccine in young children and supports the current Advisory Committee on Immunization Practices recommendation. This study provides the strongest evidence to date confirming the effectiveness of trivalent influenza vaccine in children <2 years of age. (Read the full article)

Children with attention-deficit/hyperactivity disorder (ADHD) have poorer academic and social functioning and more language problems than typically developing peers. However, it is unknown how language problems impact the academic and social functioning of these children.

Language problems are common in children with ADHD and are associated with markedly poorer academic functioning independent of ADHD symptom severity and comorbidities. There was little evidence that language problems were associated with poorer social functioning for children with ADHD. (Read the full article)

Up to 50% of children with attention-deficit/hyperactivity disorder (ADHD) meet criteria for a comorbid anxiety disorder. Despite the high prevalence of anxiety in these children, the impact of anxiety on the lives of children with ADHD has been largely overlooked.

Presence of ≥2 anxiety comorbidities in children with ADHD was associated with poorer child quality of life, daily functioning, and behavior. Multiple anxiety comorbidities were associated with poorer functioning for children with both ADHD-Inattentive and ADHD-Combined presentation. (Read the full article)

The widely disseminated National Institute on Alcohol Abuse and Alcoholism screening tool for adolescent alcohol use was developed based on epidemiologic data. It has not been validated in a clinical sample and does not screen for tobacco or drug use.

This study found that a measure that expanded the National Institute on Alcohol Abuse and Alcoholism adolescent alcohol use tool to include tobacco and drugs was sensitive and specific for identifying substance use disorders in a pediatric clinic patient population. (Read the full article)

Noonan syndrome is associated with a bleeding diathesis and abnormal coagulation tests.

Bleeding diathesis in Noonan syndrome was evaluated by using a validated bleeding score. For the first time, platelet function was fully investigated, and a significant prevalence of platelet abnormalities likely to contribute to the bleeding diathesis was found. (Read the full article)

Owing to genetic variability in its metabolism, codeine can lead to fatal toxicity or inadequate treatment in pediatric subpopulations and several guidelines have recommended against its use in children. Little is known about codeine prescribing for children in the United States.

There has been a small decline in pediatric codeine prescriptions overall in emergency departments, but no change in prescription for children who have cough or upper respiratory infection, despite professional recommendations against this practice. Substantial numbers of children are being prescribed codeine annually. (Read the full article)

Early establishment of a dental home is critical for addressing the "silent epidemic" of early childhood caries. Physicians and dentists have worked to improve children’s access to dental care, but little is known about caregivers’ role in this context.

Addressing factors that affect the establishment of a child’s dental home, such as caregivers’ dental neglect and problem-driven care-seeking behaviors, is essential. Caregiver engagement seems to be pivotal for increasing use of preventive services while decreasing episodic and problem-initiated care. (Read the full article)

Congenital pulmonary malformations are mostly identified prenatally. At birth, some children develop respiratory distress, which may be sufficiently severe to require mechanical ventilation and immediate surgery. The factors predictive of neonatal respiratory distress are not well defined.

Malformation volume and prenatal signs of intrathoracic compression are significant risk factors for respiratory complications at birth in fetuses with pulmonary malformations. In such situations, the delivery should take place in a tertiary care center. (Read the full article)

Hypothermia treatment of neonatal encephalopathy reduces death and disability from 66% to 50%; additional neuroprotective therapies are needed. We previously found in animal models that adding 50% xenon to the breathing gas during cooling doubled neuroprotection.

This clinical feasibility study used 50% xenon for 3 to 18 hours in 14 cooled infants with cardiovascular, respiratory, and amplitude-integrated EEG monitoring. This depressed seizures, with no blood pressure reduction. Xenon is ready for randomized clinical trials in newborns. (Read the full article)

Urinary tract infection (UTI) is the most common bacterial infection in febrile infants aged 1 to 90 days. It is unclear if urine microscopy offers significant benefit beyond urine dipstick as a screening test for UTI in this population.

Dipstick may be an adequate screening test for UTI in infants aged 1 to 90 days with a negative predictive value (NPV) of 98.7%. Adding microscopy increases the NPV to 99.2% but results in 8 false-positives for every UTI missed by dipstick. (Read the full article)

Practice standards for managing adult cervical spine injuries (CSIs) are well established. However, pediatric CSIs are rare and different from those of adults, preventing extrapolation from adult practice and illustrating the need for larger multicenter investigations of CSIs in children.

This study comprehensively describes CSIs in a large multicenter pediatric cohort. The large number of young children included allowed us to comprehensively explore the relationship between CSI pattern and age, mechanism of injury, comorbid injuries, surgical interventions, and neurologic outcome. (Read the full article)

Early preventive dental care is cost-effective and can reduce subsequent restorative or emergency visits. Little is known about the factors distinguishing families who receive dental care in early childhood and those who do not.

Our results suggest that among healthy children seen by primary care providers, those most in need of dental care are least likely to receive it. This highlights the importance of promoting early preventive dental care in the primary care setting. (Read the full article)

Chorioamnionitis (CAM) is a major risk factor for early-onset neonatal sepsis. The Committee on the Fetus and Newborn recommends extending the duration of antimicrobial therapy in neonates exposed to CAM and intrapartum antibiotics if laboratory data are abnormal, even if culture results are sterile.

When managed by using a strategy similar to recent Committee on the Fetus and Newborn guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy, subjected to additional invasive procedures, and had prolonged hospitalization. (Read the full article)