Parents of children with special health care needs and low-income children report more unmet specialty care needs. Care coordination is associated with increased and decreased referrals to specialty care, but whether care coordination is related to unmet needs is unknown.

Among children with special health care needs, care coordination is associated with lower odds of unmet specialty care needs regardless of whether care coordination was received within a medical home. This association was independent of household income. (Read the full article)

Administrative health insurance claims have limitations when measuring care quality.

Children’s care quality measures assessed using administrative claims alone may not accurately reflect care quality. Use of electronic health record data in combination with administrative claims data provides an opportunity for more complete measurement. (Read the full article)

Participation in youth ice hockey is increasing. Players are prone to injury because of the nature of the game. Injury patterns vary based on age, gender, and degree of contact permitted.

This study adds an updated description of injuries sustained by youth ice hockey players and associated demographic patterns, with emphasis on seriously injured children. It also evaluates health care utilization and outcomes related to youth ice hockey injuries. (Read the full article)

Electronic cigarettes have unknown health risks and youth and young adults increasingly use them. E-cigarette companies are marketing e-cigarettes using television ads. The content of these ads may appeal to young people because they emphasize themes of independence and maturity.

E-cigarette companies advertise to a broad television audience that includes 24 million youth. The reach and frequency of these ads increased dramatically between 2011 and 2013. If current trends continue, youth awareness and use of e-cigarettes are likely to increase. (Read the full article)

The US health care system transition to the ICD-10-CM will occur in October 2015. The logistical and financial impact of the transition for billing codes frequently used by pediatricians has not been studied.

The findings of this study evaluate the government-provided mappings from ICD-9-CM to ICD-10-CM for accuracy and provide the diagnostic codes used by pediatricians, which may be adversely affected by the transition to ICD-10-CM. (Read the full article)

Rapid cranial MRI is a radiation-free method to assess children with possible ventricular shunt malfunction. However, the test performance of rapid cranial MRI has never been compared with that of cranial CT, the current reference standard.

The accuracy of rapid cranial MRI was not inferior to that of CT for diagnosing ventricular shunt malfunction. Rapid cranial MRI is an important radiation-sparing diagnostic alternative for children presenting emergently with possible ventricular shunt malfunction. (Read the full article)

The traditional process-focused approach to quality improvement has not remedied NICUs’ inconsistency in quality of care delivery across clinically important measures. Global measurement of quality may induce broad, systems-based improvement, but must be formally studied.

We present a systematically developed and robust composite indicator, the Baby-MONITOR, to assess the quality of care delivered to very low birth weight infants in the NICU setting. (Read the full article)

Animal studies document dose-dependent and duration-of-therapy-dependent fluoroquinolone cartilage toxicity in weight-bearing joints. Preliminary pediatric data collected after fluoroquinolone treatment and up to 1 year posttreatment in blinded and unblinded studies suggest the possibility of cartilage toxicity in children.

These are the first prospectively collected data on fluoroquinolone musculoskeletal safety collected posttherapy from randomized, comparative studies of respiratory tract infections and analyzed at 5 years. Long-term musculoskeletal adverse events occurred with equal frequency in both levofloxacin and comparator groups. (Read the full article)

Injuries sustained by parents in combat can also have a variety of psychological effects on children in the family. However, there has been little research on the effect of parental injury on children in the civilian setting.

The effects of injury of parents impacted children’s functioning by negatively affecting the health-related quality of life of the injured children, over and above the effect of any injury itself to the child. Injury to the parent also increased the likelihood of his or her uninjured children having PTSD symptoms 5 months after the parent’s injury. (Read the full article)

Prematurely born infants commonly have abnormal metabolic screens.

Both gestational and chronological age influence metabolic profiles used to screen for inborn errors of metabolism. (Read the full article)

The definition of hypertension in children is complex because of the age-, gender-, and height-specific blood pressure algorithm. Blood pressure to height ratio was reported to easily identify hypertension in Chinese children living in a local area (Hebei Province).

Blood pressure to height ratio index is simple and accurate for screening for prehypertension and hypertension in Chinese children aged 6 to 17 years and can be used for early screening or treating Chinese children with hypertension. (Read the full article)

Since the introduction of rotavirus vaccines, diarrhea-associated health care utilization among US children has decreased substantially. Moreover, indirect benefits from rotavirus vaccination have been observed in unvaccinated children and in adults.

With increasing rotavirus vaccine coverage during 2009–2011, we observed continued reductions in diarrhea-associated health care utilization and cost. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life. (Read the full article)

Varicella vaccine is effective, but there is concern that widespread use in young children may lead to a shift in the age of infection, with potentially more severe disease later in childhood and adolescence.

This study documents that varicella vaccine resulted in a decline of varicella incidence and hospitalization in all age groups, with no shift to older age groups. (Read the full article)

Previous analyses have documented that the prevalence of children with chronic conditions is growing and is responsible for increased growth in hospital charges; however, such utilization trends have not been documented in Medicaid and the Children’s Health Insurance Program.

From 2007 through 2010 in Illinois, children with chronic conditions became Medicaid and Children’s Health Insurance Program recipients at a higher rate than healthy children. In contrast to studies of hospital data, this analysis found per-member spending decreases in most chronic condition groups. (Read the full article)

In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.

Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. (Read the full article)

Children with shaken-baby syndrome, or abusive head trauma (AHT), have lasting health and development problems. The long-term medical cost of AHT is unknown.

Patients with AHT had higher inpatient, outpatient, and drug costs compared with other children for 4 years after their abuse diagnosis, amounting to tens of thousands of dollars in excess and preventable medical care per patient with AHT. (Read the full article)

Poor health in children is associated with exposure to family violence and disruption. Telomere length has been hypothesized to be a lasting biological indicator of exposure to early adversity and potentially predictive of negative health outcomes throughout the life course.

Telomere length reflects exposure to family violence and disruption and may be an early indicator of the biological impact of early adversity. Children exposed to interpersonal violence and family disruptions had significantly shorter telomeres. Gender moderated these associations. (Read the full article)

Studies on adult patients who have Crohn disease have shown a comparative benefit of anti-TNFα versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges.

Anti-TNFα therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence. (Read the full article)

Homicide is the third leading cause of mortality in general population youth aged 15 to 29 years. Groups at greatest risk for early violent death (racial/ethnic minorities, males, poor persons, and urban youth) are overrepresented in the juvenile justice system.

We examined rates of and risk factors for firearm homicide and other causes of death in delinquents 16 years after detention. Our study analyzes gender differences; compares Hispanics, African Americans, and non-Hispanic whites; and includes a representative sample of delinquents. (Read the full article)

Rates of performing skeletal survey (SS) for young children presenting with fractures and at risk for abuse vary substantially across providers, with disparities associated with patients’ characteristics. Lack of consensus regarding indications for SS also contributes to this variation.

The results of this study provide a set of explicit consensus guidelines, based on the literature and on the knowledge of experts from several medical specialties, for identifying children with fractures who should undergo an initial SS. (Read the full article)

Caffeine has predictable effects on cardiovascular function in both adults and children. Our previous work has shown that there are gender differences in this cardiovascular response, with boys having a greater change in heart rate and blood pressure than girls.

This study shows that the gender differences in cardiovascular response to caffeine emerge after puberty and there are some differences in postpubertal girls across the menstrual cycle. (Read the full article)

Adverse childhood experiences have been shown to have long-term impacts on health and well-being. However, little work has been done to incorporate the voices of youth in understanding the range of adverse experiences that low-income urban children face.

Study participants cited a broad range of adverse experiences beyond those listed in the initial adverse childhood experience studies. Domains of adverse experiences included family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, and child welfare/juvenile justice systems. (Read the full article)

Pneumonia is a leading cause of hospitalization among children, and readmissions after discharge are common.

Eight percent of children experience a readmission within 30 days after hospital discharge for pneumonia. Readmissions are most common among young children and those with chronic medical conditions, and are associated with substantial costs. (Read the full article)

Previous studies have revealed that children in child care are frequently ill with mild illness and are unnecessarily excluded from child care at high rates.

Parent race/ethnicity, single parents, and work-related concerns are associated with increased emergent/urgent care use for a sick child excluded from child care, even for mild illnesses. (Read the full article)

Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated.

Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms. (Read the full article)

Autism prevalence is reported to be highest among non-Hispanic white children, lower in Hispanic and African American/black children, and highly variable in Asian/Pacific Islanders. More comorbid intellectual disability and delays in expressive language have been observed among Hispanic and African American children.

Maternal nativity is a risk factor for childhood autism in US populations. We observed higher risk of severe autism phenotypes in children of foreign-born black, Central/South American, Filipino, and Vietnamese mothers and US-born African Americans and Hispanics compared with US-born whites. (Read the full article)

Indoor tanning has gained widespread popularity among adolescents and young adults. Incidence rates of early-onset basal cell carcinoma also appear to be rising. Scant evidence exists on the impacts of early exposure and whether it leads to early occurrence of this malignancy.

In a US population-based study, indoor tanning was associated with an elevated risk of basal cell carcinomas occurring at or before the age of 50 years, with an increasing trend in risk with younger age at exposure among adolescents and young adults. (Read the full article)

Neurocognitive deficits, academic delays, and behavioral and emotional problems are well documented in school-age children in relation to socioeconomic disadvantage and residential instability. Despite adversity, early intervention can facilitate healthy cognitive, emotional, and social development.

Homeless youth demonstrated elevated rates of untreated psychiatric disorders, low academic achievement, and impaired neurocognition. Mental health and neurocognitive symptoms were associated with vocational outcome. Intervention beyond employment services alone is needed to improve functioning. (Read the full article)

Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.

Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families. (Read the full article)

Children born late and moderately preterm are at increased risk of developmental problems compared with term-born peers. Screening for developmental problems in the early years may thus aid in the early identification of children at risk for adverse outcomes.

The Parent Report of Children’s Abilities-Revised has good concurrent validity and 90% sensitivity and 76% specificity for identifying moderate/severe cognitive developmental delay in infants born late and moderately preterm. This parent questionnaire may be used as a clinical screening tool. (Read the full article)

Compared with their peers, pediatric residents who report exposure to community settings anticipate greater future community involvement at the end of training. The impact of community pediatrics training on actual future community involvement is not known.

Pediatricians exposed to enhanced community pediatrics training during residency report greater participation in community activities and greater related skills than their peers nationally. (Read the full article)

Sending and receiving sexually explicit picture and text messages (sexting) is related to sexual activity and risk behavior among some high school populations, yet little is known about sexting associations with sexual activity and risk behavior among middle school students.

This study is the first to examine sexting among a probability sample of middle school students and found that middle school students who text excessively and send and receive sexts are more likely to report being sexually active. (Read the full article)

Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.

Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing. (Read the full article)

Early referral of infants with critical congenital heart disease (CCHD) is recommended to reduce mortality. However, few population-based data have been published showing the relationship between CCHD neonatal mortality and timing of cardiac evaluation at a specialty center.

In neonates with CCHD, 35% were not evaluated at a cardiac center by 4 days of age. These cases accounted for a significant number of CCHD deaths. This information enhances the rationale for pulse oximetry screening of neonates for CCHD. (Read the full article)

Hookah use is increasing dramatically among US adolescents. Many consider it a safer alternative to cigarettes. Existing studies often use nonrepresentative local populations to assess prevalence and correlates of hookah use.

This study used a nationally representative sample of US high school seniors. It confirmed some previously found correlates and determined that adolescents of higher socioeconomic status were at high risk for hookah use. (Read the full article)

Available bowel preparation solutions for colonoscopy continue to represent a challenge for children and their families due to poor taste, high volume, and dietary restrictions with subsequent poor compliance and need to place nasogastric tube for administration.

Low-volume polyethylene glycol (PEG) preparations and sodium picosulphate plus magnesium oxide and citric acid (NaPico+MgCit) are noninferior to PEG 4000 with simethicon for bowel preparation before colonoscopy in children. Given its higher tolerability and acceptability profile, NaPico+MgCit should be preferred in children. (Read the full article)

Invasive pneumococcal disease causes enormous morbidity in children. The spectrum and severity of illness caused by pneumococcal serotypes not present in the current vaccine, and whether the clinical profile and severity of disease have changed, are largely unknown.

Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. (Read the full article)

As the number of chronically ill children grows in the United States, end-of-life discussions and advance directives (AD) will become increasingly important. Although pediatric palliative care is gaining interest, little is known about parental preferences regarding ADs for chronically ill children.

Knowledge about ADs is limited among caregivers of children who have chronic illness. However, interest in creating ADs is high, suggesting an unmet need and opportunity for health care providers to improve the care of children who have chronic illness. (Read the full article)

Oral vaccine responses are low in children from less-developed countries perhaps as a result of intestinal dysbiosis. New high-throughput DNA-based methods allow characterization of intestinal microbiota as a predictor of vaccine responses.

High abundance of stool Actinobacteria, including Bifidobacterium, was associated with higher responses to oral and parenteral vaccines and a larger thymus in Bangladeshi infants. Conversely, high abundance of Clostridiales, Enterobacteriales, and Pseudomonadales was associated with neutrophilia and lower vaccine responses. (Read the full article)

Passive or opt-out consent has been successfully used to recruit subjects in several investigational studies. However, institutional review boards are often inconsistent in their application of federal regulations regarding passive consent.

This study documented the variability among 24 local institutional review boards in their application of federal regulations regarding passive consent and parental acceptance of a passive consent strategy in a multicenter pediatric study. (Read the full article)

Immigrant children are more likely to be uninsured versus nonimmigrant children. The extent to which immigrant families are aware of and interested in obtaining insurance is unclear. Obstacles to participation in insurance exchanges and public insurance programs are also unknown.

Barriers for children in immigrant families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and the likelihood of working organizations likely to offer employee insurance coverage. (Read the full article)

The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.

AFIX consultations achieved short-term gains in coverage for 11- to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. (Read the full article)

Massachusetts implemented a major health reform in 2006 to reduce uninsurance, improve access to care, and increase financial protection for its citizens, but little is known about its effect on privately and publicly insured children with special health care needs.

Massachusetts health reform improved access to specialists for privately insured children with special health care needs but did not reduce uninsurance, increase access to primary care, or improve financial protection. National reform may produce similarly modest outcomes for these children. (Read the full article)

Few studies have performed precise cardiovascular assessments and regular follow-up of congenital rubella syndrome (CRS) patients’ clinical courses. A few studies have reported mortalities among children who have CRS; however, the causes of death have not been precisely described.

A total of 38 CRS cases in Vietnam were studied after a rubella outbreak in 2011. The mortality associated with pulmonary hypertension was significantly high if untreated. Conducting careful cardiologic assessments and providing continuous follow-up for each patient is required. (Read the full article)

Socioeconomic status (SES) often influences timeliness of health care delivery, even in publicly funded systems. Children need prompt surgical care for a variety of time-sensitive developmental conditions, and children of lower SES may be especially vulnerable to delays in surgery.

It is unknown whether a publicly funded system’s ability to provide timely pediatric surgical care is related to SES. In 39 327 consecutive surgical cases, we demonstrate that SES need not influence timeliness of surgical care in a publicly funded system. (Read the full article)

Delaying cord clamping beyond 30 to 60 seconds after birth seems beneficial for all infants due to blood transfusion from placenta. Experimental data have demonstrated that ventilation implemented before cord clamping improved cardiovascular stability by increasing pulmonary blood flow.

Healthy self-breathing neonates in a low-resource setting are more likely to die if cord clamping occurs before or immediately after onset of spontaneous respirations. The risk of death/admission decreases by 20% for every 10-second delay in clamping after breathing. (Read the full article)

There is growing support for adopting the milliliter as the standard unit for liquid medication instruction; teaspoon and tablespoon units can be confusing and may endorse kitchen spoon use. There are concerns that parents may not understand milliliter-based instructions.

Parents who used milliliter-only units made fewer dosing errors than those who used teaspoon or tablespoon units. Moving to a milliliter-only standard could reduce confusion and decrease medication errors, especially for parents with low health literacy and non-English speakers. (Read the full article)

Sleep disturbance affects 47% to 60% of children with atopic dermatitis and is a leading cause of impaired quality of life for the patients and their family.

Sleep disturbance in children with atopic dermatitis can be predicted by a Scoring Atopic Dermatitis index of ≥48.7, and lower nocturnal melatonin secretion might play a role in the pathophysiology. (Read the full article)

The role of inhaled nitric oxide (INO) in the treatment of newborns with congenital diaphragmatic hernia (CDH) is poorly defined and not rigorously proven. Contemporary rates of INO use for CDH have not been reported.

INO use in neonates with CDH is widespread, and has increased in many US tertiary pediatric hospitals without associated decrease in extracorporeal membrane oxygenation use or mortality. (Read the full article)

Children with autism sleep poorly compared with their peers. Sensory integration, including use of weighted blankets, is proposed as a means to reduce arousal and stress. There is, however, no evidence that weighted blankets can improve sleep for these children.

This is the first robust study to evaluate the impact of weighted blankets and show that they do not improve sleep parameters in children with autism spectrum disorder. (Read the full article)