Over the past 10 years, children’s hospitals increasingly have established pediatric palliative care programs, but little is known about the prevalence of these programs or their geographic distribution, range of services offered, staff composition, or funding.

Among the 162 hospitals that responded to this survey (71.7% response rate), 69% have a pediatric palliative care program, with substantial variation across programs in terms of how they are staffed and funded and what services they provide. (Read the full article)

An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child’s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.

How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination. (Read the full article)

Levels of daily physical activity in children are decreasing worldwide. This implies risk factors for cardiovascular and metabolic diseases.

Strength training makes children not only stronger but significantly increases their daily spontaneous physical activity outside the training intervention. (Read the full article)

Children with chronic illnesses tend to be sicker during infections than previously healthy children but are triaged in the same way, even though the validity of triage systems has not yet been evaluated in these chronically sick children.

The performance of the Manchester Triage System was lower for children with a chronic illness than for previously healthy children. Children with cardiovascular illnesses, respiratory illnesses, gastrointestinal illnesses, or other congenital or genetic defects were especially at risk of being undertriaged. (Read the full article)

NF1 is the commonest single-gene neurodevelopmental disorder with known neurobiology and developmental impact on attention and cognition. Its impact on social functioning is described but poorly understood, with no population-based study of autism spectrum disorder (ASD) prevalence in the disorder.

This epidemiological study shows high prevalence of 25% ASD in NF1 not explained by learning difficulties. ASD should be considered during clinical practice with NF1. Further research into NF1 as a single-gene model of ASD is warranted. (Read the full article)

Several studies have documented earlier onset of pubertal maturation in girls, with several potential factors attributed to the earlier onset.

This study demonstrates earlier maturation in white non-Hispanic girls, with greater BMI linked as a major factor. The entire distribution of pubertal timing has shifted to a younger age, suggesting redefinition of ages for both early and late maturation. (Read the full article)

The World Health Organization estimates that ~700 million children breathe tobacco smoke polluted air, particularly at home. Educational strategies either directly or indirectly targeting household decision-makers through other family members are effective in reducing children's exposure in private homes.

Intensive intervention was effective in decreasing children’s personal exposure to secondhand smoke (SHS), educating mothers about SHS, and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s personal exposure to SHS was not statistically significant. (Read the full article)

Preterm infants are born with low serum levels and low body stores of tocopherol. Serum levels ≥0.5 mg/dL are required for protection against lipid peroxidation. Previous studies have shown good intestinal absorption of vitamin E given intragastrically to preterm infants.

Serum α-tocopherol increases after a single 50-IU/kg dose of vitamin E as dl-α-tocopheryl acetate given intragastrically to very preterm infants soon after birth; however, 30% of infants still have serum α-tocopherol level <0.5 mg/dL 24 hours after dosing. (Read the full article)

Previous research has shown the following: the mere presence of weapons can increase aggression, dubbed the "weapons effect"; violence in films has increased over time; and violent films can increase aggression.

This study examines a potential source of the "weapons effect": the presence of guns in films. In just 20 years, gun violence in PG-13 films (age 13+) has increased from the level in films rated G/PG to the point where it exceeds the level in R films. (Read the full article)

To prevent asthma exacerbations, asthma guidelines recommend ongoing monitoring of patients’ asthma symptoms to promote timely adjustments of therapy to achieve and maintain optimal control. Existing tools, validated for ongoing monitoring, have significant limitations in children.

Our study established longitudinal validation of the Asthma Symptom Tracker, a novel tool designed for use by children or their parents to facilitate ongoing monitoring of patients’ asthma symptoms and proactive medical decision-making to prevent acute exacerbations. (Read the full article)

Peripherally inserted central catheters (PICCs) are essential to deliver life-saving treatment to neonates. Longer PICC dwell times may increase the risk of central line–associated bloodstream infections (CLABSIs) in neonates, but previous studies have yielded inconsistent results, likely due to different study designs, analytic methods, and small sample sizes.

The risk of CLABSIs increases during the 2 weeks after PICC insertion and remains elevated for the catheter duration. These data support daily review of PICC necessity, optimization of catheter maintenance practices, and consideration of novel strategies to prevent CLABSIs. (Read the full article)

Bullying involvement is associated with deleterious psychological, educational, and health effects. However, little is known about relations between bullying involvement and sexual risk-taking behaviors or whether similar patterns hold for heterosexual and gay, lesbian, bisexual, transgendered, or questioning adolescents.

Among adolescents, bullies and bully-victims engaged in more casual sex and sex under the influence than their peers. Controlling for demographic characteristics and other victimization exposures, bully and bully-victim status predicted sexual risk taking but primarily for heterosexual adolescents. (Read the full article)

In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.

Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention. (Read the full article)

Certain characteristics of the sleep environment increase the risk for sleep-related, sudden, and unexplained infant death. These characteristics have the potential to generate asphyxia. The relationship between the deaths occurring in these environments and neurochemical abnormalities in the brainstem that may impair protective responses to asphyxia is unknown.

We report neurochemical brainstem abnormalities underlying cases of sudden infant death that are associated with and without potential asphyxial situations in the sleep environment at death. The means to detect and treat these abnormalities in infants at risk are needed. (Read the full article)

Preterm infants can be successfully resuscitated with <100% oxygen (O₂); however, initiation with room air remains controversial. Current Neonatal Resuscitation Program (NRP) guidelines suggest using air or blended O₂ to titrate O₂ to meet target preductal saturation goals.

This is the first trial to compare a limited O₂ strategy to target NRP–recommended transitional goal saturations versus a high O₂ strategy in preterm infants. The limited O₂ strategy decreased integrated excess oxygen and oxidative stress and improved respiratory outcomes. (Read the full article)

Global health is of increasing interest and relevance to North American pediatric trainees. Opportunities for resident global health training and exposure are most often limited to electives or trainees in dedicated global health tracks.

A series of short, structured, participatory global child health modules improved knowledge and were well received and integrated within academic programs. Such modules enable global health learning for all residents, including those who never intend to practice overseas. (Read the full article)

Bacteremia occurs in 2.2% of febrile infants who have a blood culture drawn. Regional data suggest that Escherichia coli, group B Streptococcus, and Staphylococcus aureus are leading causes; however, the geographic boundaries of these data limit universal applicability.

This is the first national study examining epidemiology of bacteremia in febrile infants admitted to a general inpatient unit. The most common pathogens were Escherichia coli (42%), group B Streptococcus (23%), and Streptococcus pneumoniae (6%). No Listeria monocytogenes was identified. (Read the full article)

Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined.

Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk. (Read the full article)

Young age at first sexual intercourse (FSI) is related to risk-taking behaviors and negative outcomes. Previous studies using a cohort or cross-sectional design have concluded that younger age at menarche (AAM) is related to younger age at FSI.

This large birth cohort study is the first to address the temporal relationship between AAM and FSI. We found that younger AAM does not confer higher risk of early FSI, whether in terms of calendar age or time since menarche. (Read the full article)

Stable health insurance coverage facilitates access to health care. Despite expanded coverage options for children, parents report barriers to accessing insurance programs for their children, including uncertainty about a child’s coverage status and eligibility.

Electronic health records can be used as an emerging data source for conducting health insurance surveillance to track trends in patients’ insurance coverage status, and to identify patients who may benefit from outreach and support to obtain and maintain coverage. (Read the full article)

Prenatal and postnatal organophosphate (cholinesterase inhibitor) pesticide exposure has been associated with delays in attention, memory, intelligence, and inhibitory control. Two recent studies reported decreased attention and working memory with greater exposure to organophosphates in boys but not in girls.

This is the first study to report associations between decreased acetylcholinesterase activity, a stable marker of cholinesterase inhibitor pesticide exposure, and lower overall neurodevelopment, attention, inhibitory control, and memory. These associations were present in boys but not in girls. (Read the full article)

Late-onset sepsis is a frequent complication of prematurity, contributing to morbidity and mortality. Although evidence is accumulating that administration of probiotics to very preterm infants reduces necrotizing enterocolitis (NEC) and all-cause mortality, the effect on late-onset sepsis is less clear.

The probiotic combination Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis reduced NEC in very preterm infants, but not mortality or late-onset sepsis. Probiotics may be of greatest global value in neonatal settings with high rates of NEC. (Read the full article)

Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.

In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development. (Read the full article)

Although community engagement is considered an important professional role of physicians, there has been declining involvement of pediatricians in community child health activities. Whether enhanced training is associated with increased involvement is unclear.

This study reveals a continued decline in pediatricians’ involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians’ community involvement. (Read the full article)

Preterm birth is associated with increased morbidity during childhood. Many studies have focused on outcomes for preterm births before 32 weeks’ gestation, but there are few follow-up data for late preterm infants (34–36 weeks’ gestation).

The risk of respiratory admission during childhood decreased with each successive week in gestation up to 40 to 42 weeks. The increased risk is small for late preterm infants, but the number affected is large and has an impact on health care services. (Read the full article)

Several studies have suggested that very low birth weight young adults have increased risks of physical and health problems, educational underachievement, and poorer social functioning than their peers, but there are limited population-based and longitudinal data.

Former VLBW young adults in this national cohort scored as well as term controls on many measures of health and social functioning, including quality-of-life scores, with some differences largely confined to those with disability at age 7 to 8 years. (Read the full article)

Adverse effects of excess weight are likely related to both obesity severity and duration. Little is known about the contribution of adolescent weight status to development of specific comorbid conditions in adults.

Severe obesity at age 18 was independently associated with increased risk of lower extremity venous edema, walking limitation, kidney dysfunction, polycystic ovary syndrome, respiratory conditions, diabetes, and hypertension in adulthood. (Read the full article)

Breast milk is protective against many conditions, but its role in allergy has not been established. Infant-feeding recommendations support exclusive breastfeeding for 26 weeks, whereas allergy prevention recommendations advise exclusive breastfeeding for 4 to 6 months with continued breastfeeding thereafter.

Evidence that continued breastfeeding while solids are introduced into the diet and delaying the introduction of solids until at least 17 weeks of age are associated with fewer food allergies. (Read the full article)

Few data on treating children hospitalized for influenza with neuraminidase inhibitors are available, contributing to uncertainty regarding the benefits of treatment.

This study of nearly 800 critically ill children suggests that treatment with neuraminidase inhibitors improves survival from influenza. This message needs additional emphasis, given that in the past 2 seasons over one-third of cases did not receive antiviral treatment. (Read the full article)

Socioeconomic status is known to influence health and health care utilization, but few studies have explored the relationship between community-level income and inpatient resource utilization for children.

In a large sample of pediatric hospitalizations, lower community-level household income is associated with higher inpatient costs of care for common conditions. These findings highlight the need to consider socioeconomic status in health care system design and reimbursement. (Read the full article)

Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease, resulting in morbidity. Magnesium is a vasodilator and has been shown to improve red blood cell hydration. Previous small studies have suggested that treatment with magnesium may decrease VOEs.

Intravenous magnesium sulfate is well tolerated in relatively high doses but had no effect on the length of stay in hospital, pain scores, or cumulative analgesia used in children admitted with painful VOEs in sickle cell disease. (Read the full article)

Screen time has risen to unprecedented levels among youth. Greater television time is known to be associated with gains in pediatric adiposity, but few studies have examined the longitudinal relations of other forms of screen-based media with weight gain.

Among adolescents aged 9 to 19 years, television viewing was the type of screen time most consistently associated with gains in BMI. However, time with digital versatile discs/videos and video/computer games was also associated with gains in BMI among girls. (Read the full article)

Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time.

This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. (Read the full article)

Pediatric surgery is performed in a variety of hospital types. General surgeons as well as fellowship-trained pediatric surgeons and surgical subspecialists perform inpatient operative procedures on infants and children. The distribution of procedures between specialists is not well characterized.

This study describes the demographics of pediatric surgery: the hospital type, the surgical procedures, and the quantity of inpatient pediatric surgery in the U.S. today. By implication, the data has much to inform health care about hospital and practitioner workforce. (Read the full article)

Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors.

The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. (Read the full article)

One study examined the incidence of obesity among low-income children aged <5 years who participated in federally funded child health and nutrition programs during 1985–1990. The study examined the variations by baseline age but not by gender or race/ethnicity.

This study provides most recent data on incidence and reversing of obesity and variations across gender, baseline age, and racial/ethnic subgroups among young low-income children. We conducted multivariable analyses to examine the relative risk of obesity in population subgroups. (Read the full article)

Parents influence their child’s overweight development through lifestyle-related parenting practices. Although broader parenting dimensions may also affect children’s BMI, reverse causality is possible and there have been calls to examine the possible impacts of fathers.

More consistent parenting prospectively predicted lower child BMI with effects equally strong for fathers and mothers. There was little evidence of child BMI influencing parenting. Improved child BMI could be among the benefits of promoting parenting consistency of both parents. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health condition diagnosed in childhood, is highly heritable, and more common in boys. Although studies have identified perinatal risk factors, no one has investigated perinatal risk factors separately in boys and girls.

Contrary to other studies, low birth weight, postterm pregnancy, low Apgar scores, and fetal distress were not risk factors for ADHD irrespective of gender. Early term deliveries increased the risk of ADHD, and oxytocin augmentation in girls may be protective. (Read the full article)

Violence from school staff toward children is anecdotally widespread, but there are few empirical data on prevalence and health consequences, especially in low-income settings.

Despite a ban on corporal punishment, just over 52% of children in Luwero District experienced physical violence from school staff members in the previous week. This was associated with poor mental health in boys and girls and poor educational performance in girls. (Read the full article)

Bronchiolitis is a leading cause of hospitalization for children, yet variability in its management persists. To promote evidence-based care, the American Academy of Pediatrics published practice guidelines in 2006 that advocate primarily supportive care for this self-limited disease.

Since publication of the guidelines in 2006, few studies have evaluated their impact on diagnostic testing and treatment. This study documents positive changes in resource use among hospitalized patients with bronchiolitis over an 8-year period. (Read the full article)

Use of behavioral health (BH) screens in pediatrics have increased identification of children with BH issues. Screening rates increased in Massachusetts after it was mandated, as did the volume of some mental health services.

This is the first study of children after Massachusetts mandated behavioral screening began. Almost 40% of children who screened positive were newly identified. Being male, having a BH history, and being in foster care predicted a positive screen. (Read the full article)

The demand for donor kidneys for transplantation exceeds supply. En bloc kidney transplantation and donation after determination of circulatory death from pediatric donors increases the potential donor pool.

Newborn infants undergoing elective withdrawal of life support in the NICU are a previously unrecognized source of potential kidney donors. (Read the full article)

Early timing of puberty and affiliation with deviant friends are associated with higher levels of delinquent and aggressive behavior. Early-maturing adolescents tend to affiliate with more-deviant peers and appear more susceptible to negative peer influences.

Young early-maturing girls do not yet associate with deviant friends but are more susceptible to negative peer influences. Early puberty effects are stable over time for delinquency but dissipate for aggression. Most of these relationships are invariant across race/ethnicity. (Read the full article)

Increasing numbers of hospitals are instituting 24/7 in-hospital pediatric intensivist coverage. Data regarding patient outcomes are mixed and the impact on housestaff education remains unknown.

This study quantifies the perceived impact of in-hospital attending coverage on pediatric resident and critical care fellow education and also investigates the growing concern that increasing supervision may contribute to housestaff being less well prepared for independent clinical practice. (Read the full article)

Youth are frequent consumers of movies that contain high levels of violence, and violent content in films, especially those rated PG-13, has been increasing over time.

Content analyses seldom examine how violence is portrayed with other health risk behaviors, such smoking, drinking, and sex. This study presents an innovative way to characterize on-screen violent content and demonstrates the extent to which risk behaviors co-occur within films. (Read the full article)

Broad-spectrum antibiotics are frequently used to empirically treat children hospitalized with community-acquired pneumonia despite recent national recommendations to use narrow-spectrum antibiotics.

Narrow-spectrum antibiotics are similar to broad-spectrum antibiotics for the treatment of children hospitalized with community-acquired pneumonia in terms of clinical outcomes and resource utilization. This study provides scientific evidence to support national consensus guidelines. (Read the full article)

Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders.

Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. (Read the full article)

Inconsistent results have been reported on the association between sleep duration and blood pressure (BP) in children, likely as a result of inadequate adjustment for confounders and the use of different time frames in assessing sleep duration.

Short sleep duration and poor sleep quality are associated with higher BP in normal-weight adolescents. One night of adequate sleep may partially ameliorate the risk of high BP but cannot completely reverse the effect of chronic sleep insufficiency. (Read the full article)

Hypertonic saline (3% and 5%), has been shown to improve clinical severity scores and reduce inpatient length of stay, and was associated with a trend toward lower admission rate in acute bronchiolitis.

We are not aware of any previous data using 7% hypertonic saline in bronchiolitis. Our results suggest that 7% saline does not lower clinical severity of illness, admission rate, or length of stay, when compared with normal saline. (Read the full article)

Better postnatal growth, especially head growth, associates with better cognitive development in preterm infants. Suboptimal postnatal growth is more common in infants with poor antenatal growth than in infants with normal growth.

Good weight gain and head circumference growth until 2 years was associated with better 5-year cognitive outcome in non–small for gestational age infants. Good head circumference growth around term age benefits the cognitive outcome of small for gestational age infants. (Read the full article)