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)

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)

Developmental screening using standardized tools has been endorsed by professional groups to improve rates of identification and referral for young children who have developmental delays. Little is known about the effectiveness of these tools among a high-risk urban population.

Using a randomized design, we found that a program of developmental screening improved the percentage and time to identification of developmental delay, referral, and eligibility for early intervention among a poor, racially diverse urban population of young children. (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)

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)

Socioeconomic status (SES) is inversely related to mortality and health in children; the higher an individual’s SES, the less likely illness and death. It is unknown whether the association of SES and pediatric mortality exists in the inpatient setting.

Within children’s hospitals, in-hospital mortality is inversely associated with SES, but is lower than expected for even the lowest SES quartile. The association between SES and mortality varies by clinical service line. (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)

Because pediatric appendicitis is challenging to diagnose, computed tomography (CT) is used frequently. Childhood radiation exposure is associated with increased risk of cancer. Ultrasound avoids radiation exposure but is less sensitive for appendicitis than CT.

Controlling for referral bias, evaluation at a community compared with a children’s hospital is associated with higher CT and lower ultrasound use before appendectomy. CT and ultrasound accuracy for appendicitis in children varies with hospital type. (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)

Paternal mental disorders during the postnatal period are associated with an increased risk for behavioral and emotional problems in their children; however, less is known about the effect of fathers’ mental health during pregnancy on children’s development.

The study demonstrated a positive association between fathers’ prenatal mental health and their children’s subsequent socioemotional and behavioral development. Psychological distress in fathers was associated with a risk for emotional difficulties in their children at 36 months of age. (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)

First drink before age 15 greatly increases the likelihood for later alcohol abuse or dependence. Separate investigations have linked many variables to alcohol initiation, but few have attempted to identify the optimal combination of predictors for age of alcohol initiation.

This article supports the screening questions selected in the joint National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics initiative to identify and initiate intervention in youth at risk for early use of alcohol. (Read the full article)

Previous studies suggest that hospitals under the greatest financial strain may be more prone to adverse events because they have limited resources to invest in quality and safety.

The patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories. (Read the full article)

A number of studies have demonstrated community acceptance of Safe Routes to School interventions as well as their success in addressing perceptions about safety, but little is known about their effectiveness in reducing pedestrian injury risk in school-aged children.

Implementation of a Safe Routes to School program in New York City may have contributed to a substantial reduction in school-aged pedestrian injury rates, with the effects largely limited to school-travel hours in census tracts with these interventions. (Read the full article)

Complementary and alternative medicine (CAM) use is common among children, especially those with chronic, recurrent, or incurable conditions. Concurrent use of CAM with conventional medications is of concern and needs to be assessed, especially in vulnerable patient populations.

CAM use is high among pediatric cardiology, gastroenterology, neurology, oncology, and respiratory patients, most of whom use CAM concurrently with conventional care. This study provides additional evidence to suggest the use of CAM be included in routine patient history taking. (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)

Presleep activities (eg, television watching) have been implicated in the declining sleep duration of young people. However, previous research reported on selected presleep activities, raising the possibility that important activities in this period are not accounted for.

This is the first study in youth to construct the presleep period by using a use-of-time approach. Twin trajectories of higher screen time and lower nonscreen sedentary time/self-care were evident in late sleepers, with the opposite pattern occurring in early sleepers. (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)

Survival estimates for preterm infants are vital for counseling parents, informing care, and planning services. Widely use estimates of in-unit survival derived from a large UK population for infants born at <33 weeks’ gestational age have been available since 1999.

These survival charts have been updated and will be of use to clinicians, parents, and managers. An alternative method for graphical representation of survival probabilities is offered: contour survival plots. (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)

Care coordination has been proposed as a key mechanism for increasing quality and reducing costs of care. Little is known about the degree to which disparities exist in care coordination or whether having high-quality primary care attenuates disparities.

A considerable proportion of parents reported unmet care coordination needs for their children, especially parents of children with special health care needs. Black and Latino children also may have more unmet needs because they received family-centered care less often. (Read the full article)

A small number of studies have found that the introduction of smoke-free legislation has been associated with a reduction in hospital admissions and emergency department visits for asthma.

The implementation of smoke-free legislation in England was associated with an immediate 8.9% reduction in hospitalizations for asthma along with a decrease of 3.4% per year. (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)

Bilateral acute otitis media (AOM) is considered more severe than unilateral AOM, and several guidelines recommend more active management of bilateral AOM. However, severity of symptoms and otoscopic signs of bilateral and unilateral AOM have previously not been comprehensively studied.

Bilateral AOM seems to be clinically only a slightly more severe illness than unilateral AOM. When assessing AOM severity, bilaterality should not be used as a determining criterion; instead, the child’s symptoms together with otoscopic signs should also be acknowledged. (Read the full article)

Prevalence of hypertension in children increased significantly over the past few decades, tracks into adulthood, and is a major risk factor for cardiovascular disease. However, current prevalence estimates in children have largely been based on studies conducted in school environments.

The current study reports the prevalence of childhood hypertension in community pediatric practice, which provides a typical pediatric examination environment, unlike blood pressure measured in school. The results show a significantly lower prevalence than what has previously been reported. (Read the full article)

A policy of intubation, mechanical ventilation, and surfactant administration is commonly used for the treatment of respiratory distress syndrome worldwide; however subsequent development of bronchopulmonary dysplasia remains as risk with this standard approach.

Noninvasive surfactant administration technique during spontaneous breathing (Take Care) along with nasal continuous positive airway pressure support successfully reduces the need for further respiratory support and bronchopulmonary dysplasia rate in very low birth weight infants. (Read the full article)

In inverse proportion to the steadily declining under-5 mortality rate, prevalence of childhood disability has doubled in the past decade in Bangladesh. The Rapid Neurodevelopmental Assessment (RNDA) tool has been shown to be reliable and valid for assessment of a range of neurodevelopmental impairments (NDIs) and disabilities in children younger than 2 years. There is currently a lack of professional expertise for assessing NDIs in 2- to 5-year-old children in low- and middle-income countries.

We developed a set of instruments as part of the RNDA for administration by a single professional with experience in child development to assess >2- to 5-year-old children for a wide range of NDIs. The tool was acceptable to mothers, interrater reliability was high, and proportions of children with NDIs were elevated among the lowest income groups and in stunted children, demonstrating discriminant validity. The RNDA was valid for identifying >2- to 5-year-old children with a range of NDIs, especially in cognitive, behavior, and motor functions. Validity of the RNDA for vision, hearing, and seizure disorders needs further research. (Read the full article)

Practice characteristics, such as practice size, have been associated with the readiness of adult primary care practices for medical home certification. Little is known about how ready primary care practices for children are for medical home certification.

Primary care practices for children attained only 38% of the infrastructure required for medical home certification. Smaller practice size was significantly associated with lower infrastructure scores. Medical home programs need effective approaches to support practices with limited resources. (Read the full article)

Peer victimization predicts numerous health risks. Lesbian, gay, and bisexual (LGB)-identified youth report greater peer victimization than do heterosexual-identified youth. No longitudinal studies have been conducted on developmental trends of peer victimization and emotional distress among LGB and heterosexual youth.

We provide the first longitudinal evidence on developmental trends of peer victimization and emotional distress for LGB- and heterosexual-identified youth. The findings suggest peer victimization of LGB-identified youth decreases in absolute, but not necessarily relative, terms and contributes to later emotional distress disparities. (Read the full article)

Current measures of risk stratification in the pediatric surgical literature are specialty specific. Although these risk scores have been validated as useful predictors of adverse outcomes, no measures currently exist to assess the full spectrum of pediatric surgery.

Our study generates a multispecialty mortality risk score for pediatric surgical patients that can be used by physicians to identify high-risk patients as well as provide a measure of risk adjustment for surgical outcomes. (Read the full article)

Amblyopia affects 2% to 4% of the US population and is preventable In January 2011, the US Preventive Services Task Force concluded there is insufficient evidence to support vision screening in children younger than age 3 years.

Results of the Iowa photoscreening program in 210 695 children older than 11 years suggest photoscreening reliably detects amblyogenic risk factors in children 1 to 3 years of age, and we recommend photoscreening children starting at 1 year of age. (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)

Provider training level is associated with lower rates of successful tracheal intubation in selected neonatal settings. However, little is known about the association of training level with tracheal intubation success and adverse events in the PICU.

Our results demonstrate the association of training level on the first attempt and overall success rate as well as the incidence of adverse tracheal intubation–associated events in a large-scale, prospective assessment across 15 academic PICUs. (Read the full article)

Research indicates that adolescents who perceive their school to have a positive socioeducational environment are at reduced risk of developing depressive symptoms. However, there is limited evidence that school environments can influence adolescent emotional health independently from individual perceptions.

This multilevel longitudinal study shows that better school socioeducational environments, as assessed at the school level, reduce the prospective risk of depressive symptoms in adolescents. This association is shown to be independent from confounders and stronger in girls than boys. (Read the full article)

Urban children suffer disproportionately from asthma, and suboptimal treatment with preventive medications is common. Although several programs have been developed to reduce morbidity for urban children with asthma, their economic feasibility and sustainability remain unknown.

Our study demonstrates that the school-based asthma therapy program could be an economically effective program for children aged 3 to 10 years attending preschool or elementary school in a city school district, at the cost of $10/symptom-free day. (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)

In humans, the brain growth spurt begins in the last trimester of pregnancy and extends through the first 2 years of life. Studies show poor cognitive and motor development among children who have iron deficiency anemia in infancy.

Prenatal iron deficiency anemia in the third trimester affects child mental development. Prenatal micronutrient supplementation with sufficient iron protects child mental development even when the woman’s iron deficiency anemia is not properly corrected during pregnancy. (Read the full article)

Impaired visual development has been reported in infants born to mothers prescribed methadone in pregnancy. Immature visual evoked potentials have been reported in this population, but data were confounded by gestation, growth restriction, and illicit drug use.

Visual evoked potentials are small and immature in infants exposed to methadone and other drugs of misuse in utero. These changes are independently associated with methadone exposure and persist after controlling for gestation, socioeconomic deprivation, alcohol consumption, and cigarette smoking. (Read the full article)