The Medical Home: Health Care Access and Impact for Children and Youth in the United States
The medical home is recognized as a mechanism for ensuring quality health care for children with special health care needs and adults with chronic conditions. Few studies address the extent to which all children have a medical home.
This article provides a comprehensive assessment of the proportion of children who have a medical home, the health and social correlates of having a medical home, and its impact on receipt of preventive care and unmet need.
Fathers' Depression Related to Positive and Negative Parenting Behaviors With 1-Year-Old Children
Paternal depression affects fathers' interactions with their children. However, little is known regarding the association between paternal depression in fathers of young children and specific parenting behaviors commonly discussed at well-child visits.
Depressed fathers were nearly 4 times more likely to report spanking and less than half as likely to report consistently reading to their 1-year-old children. Notably, 77% of depressed fathers reported talking with their child's doctor in the previous year.
Parent Diet Modification, Child Activity, or Both in Obese Children: An RCT
Childhood obesity interventions that include parents are effective, but effectiveness wanes over time. Few trials exist with follow-up beyond 1 year or that compare the efficacy of diet versus physical activity.
This trial addresses the current methodological limitations in childhood obesity interventions. We found that reductions in relative body weight can be sustained for 2 years. Targeting parents to reduce total energy intake in children is more effective than only targeting children to increase activity.
Acceptability of Testing Children for Tobacco-Smoke Exposure: A National Parent Survey
Tests to measure children's exposure to tobacco smoke exist but are not currently used in the child health care setting. No previous national studies have assessed whether parents would accept testing of their children in this context.
This study shows that the majority of parents in general, and even parents who smoke, want their children tested for tobacco-smoke exposure in the context of the child's health care setting.
Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants
Results of recent studies conducted on relatively small study populations have suggested an association between packed red blood cell transfusion and necrotizing enterocolitis (NEC) in hospitalized premature infants. Causality, the odds of NEC after transfusion, and characteristics of the blood transfused preceding NEC are not known.
This study was conducted in a large population, and the results confirm the association between packed red blood cell transfusion and NEC. Adjusted odds for NEC in infants who received a transfusion were 2.3, and there was a preponderance of male donors for blood transfused preceding NEC.
Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits
Little is known about the extent to which providers model proper use of asthma devices to children or the extent to which providers have the children demonstrate how they use their devices during medical visits.
The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.
Abusive Head Trauma in Children: A Comparison of Male and Female Perpetrators
Several studies have examined the relationship between perpetrators of abusive head trauma and their victims. However, no study has evaluated the effect of perpetrator gender on victim presentation, victim clinical outcomes, and perpetrator legal outcomes.
This study reports significant gender differences in perpetrators of abusive head trauma in children. Male perpetrators were younger and more likely to confess and be convicted. Victims of male perpetrators had more serious acute presentations and neurosurgical intervention and suffered worse clinical outcomes.
Compliance With National Guidelines for Physical Activity in U.S. Preschoolers: Measurement and Interpretation
Physical activity plays an important role in the development of preschool-aged children (aged 3–5 years). Public health guidelines exist that specify a minimal level of physical activity preschoolers should accumulate daily. Previous studies conclude that the majority of preschoolers do not meet these guidelines.
Ambiguity in the interpretation of the guidelines, coupled with multiple ways to quantify physical activity, precludes definitive statements regarding the prevalence of sufficiently active preschoolers. Concerted attention is required for developing explicit guidelines and standardization of physical activity measures.
Postnatal-Onset Microcephaly: Pathogenesis, Patterns of Growth, and Prediction of Outcome
Microcephaly is a common disorder of childhood with a generally unfavorable prognosis. Most microcephaly is congenital, although some cases first appear postnatally. The outcome of postnatal-onset microcephaly varies, and no predictors of development have previously been identified.
This study found that developmental outcome in postnatal-onset microcephaly was normal in a substantial minority (25%). Three-quarters of those with normal development were idiopathic, with the remainder encephaloclastic. Better somatic growth (weight, height) was associated with a normal developmental outcome.
Evidence Suggests There Was Not a “Resurgence” of Kernicterus in the 1990s
Kernicterus is the driving concern behind treating neonatal hyperbilirubinemia. Some authors have suggested that the incidence of kernicterus increased dramatically during the 1990s, but the evidence to support such an increase is weak.
This population-based study uses independent sources of data from the California Department of Developmental Services and United States national cause-of-death registries to estimate kernicterus incidence. Both sources suggest a flat incidence rate of <1 in 100 000 live births per year.
Intravenous Immunoglobulin in Neonates With Rhesus Hemolytic Disease: A Randomized Controlled Trial
Treatment with intravenous immunoglobulin for hemolytic disease of the newborn has been proposed as an alternative therapy to reduce the incidence of exchange transfusion. However, its efficacy has not yet been definitively demonstrated in large randomized controlled trials.
Prophylactic intravenous immunoglobulin does not reduce the need for exchange transfusion or the rates of other adverse neonatal outcomes. Our findings do not support the use of intravenous immunoglobulin in neonates with rhesus hemolytic disease.
Growth Standards of Infants With Prader-Willi Syndrome
Standardized growth curves do not exist for infants with Prader-Willi syndrome. Syndrome-specific growth charts are required for monitoring growth and nutritional status, particularly during growth hormone treatment and follow-up for this disorder during infancy.
Standardized growth curves are reported to be used in monitoring growth and development of infants with Prader-Willi syndrome of both genders from 0 to 36 months of age.
Medically Underserved Girls Receive Less Evaluation for Short Stature
Boys outnumber girls ∼2 to 1 in growth hormone (GH) registries and subspecialist endocrine clinics that evaluate short stature, yet the prevalence of growth-faltering in an urban pediatric primary care population was not related to gender.
Patterns in diagnostic testing of children with growth-faltering by their primary care pediatricians may lead to underdiagnosis of Turner syndrome and GH deficiency among girls.
State Laws Regarding the Retention and Use of Residual Newborn Screening Blood Samples
Previous research has demonstrated that many state newborn screening laboratories do not have policies regarding the retention and use of residual newborn screening blood samples. Several national organizations have recommended that states develop policies regarding this important issue.
This study evaluated the extent to which issues related to the retention and use of residual newborn screening blood samples are addressed by state statutes and regulations. The recent lawsuits in Texas and Minnesota regarding this issue also are discussed.
Self-directed Versus Traditional Classroom Training for Neonatal Resuscitation
The educational efficiency of the neonatal resuscitation course needs to be increased to allow time for simulation and debriefing. Video self-instruction with a personal mannequin has been used to teach adult basic life support.
Self-directed education successfully shifts the acquisition of cognitive and basic procedural skills outside the classroom, which allows instructors to shorten the course while adding simulation and debriefing activities.
Nutritional Supplements and Other Complementary Medicines for Infantile Colic: A Systematic Review
Research into complementary and alternative medicines for infantile colic have suggested several therapies that can be beneficial, ranging from supplements to manipulation, sugar solutions, herbal extracts, massage, and reflexology.
This is the first systematic review of all complementary and alternative medicines and nutritional supplements for the treatment of infantile colic. Encouraging evidence for fennel extract, mixed herbal tea, and sugar solutions were found, but all included trials have limitations.
A Double-Blind, Placebo-Controlled Study of Atomoxetine in Young Children With ADHD
Atomoxetine has been demonstrated to be safe and efficacious for the treatment of attention-deficit/hyperactivity disorders in children 6 years of age and older.
This study provides the first randomized controlled data from children under the age of 6 years. In this trial of 101 5- to 6-year-old children, atomoxetine generally was well tolerated and reduced core attention-deficit/hyperactivity disorders symptoms, although significant impairment persisted.
Sudden Deaths and Severe Apparent Life-Threatening Events in Term Infants Within 24 Hours of Birth
Sudden infant death and a severe apparent life-threatening event may occur in term newborns within 24 hours of birth.
Using a national reporting system, the incidence of sudden infant death and a severe apparent life-threatening event within 24 hours of birth was found to be 2.6 in 100 000 live births in Germany. More than half of these events occurred in the first 2 hours of life.
Cognitive Function After Intrauterine Growth Restriction and Very Preterm Birth
Active delivery of very preterm fetuses because of absent or reversed end-diastolic (ARED) blood flow is controversial. The combined effect of extreme prematurity and intrauterine growth (IUGR) with ARED blood flow is not fully understood.
This is the first controlled study on cognition in very preterm infants actively delivered because of ARED flow. Cognitive function was especially unfavorable in boys born after IUGR with ARED blood flow.
Neurologic Outcomes at School Age in Very Preterm Infants Born With Severe or Mild Growth Restriction
The association between SGA and neurodevelopmental outcome in the preterm infant is not well defined, with variable and evolving definitions of SGA.
We investigated the consequence of classic SGA (<10th percentile) and also a category called mild-SGA (10th–19th centile) (M-SGA) in the premature population. Both SGA and M-SGA were associated with mortality and with cognitive, behavioral, and school difficulties.
Pediatric Trauma BIG Score: Predicting Mortality in Children After Military and Civilian Trauma
There is little published on the epidemiology of pediatric trauma in the recent conflicts in Iraq and Afghanistan, and no widely accepted and validated pediatric trauma score exists for children.
This study describes the epidemiology of pediatric trauma in a military setting, uses regression methodology to derive a mortality prediction score, and further validates this score in a separate civilian trauma population.
Risk Factors for Hand, Foot, and Mouth Disease and Herpangina and the Preventive Effect of Hand-washing
Hygiene and social distancing are recommended control measures for hand, foot, and mouth disease and herpangina. However, empirical data to support this recommendation are limited.
We found a strong protective effect from better hand-washing habits during an outbreak of hand, foot, and mouth disease and herpangina. A reduction in risk of >95% was supported by a consistently increasing dose-response effect after controlling for other exposures.
A Strong Synergism of Low Birth Weight and Prenatal Smoking on Asthma in Schoolchildren
Smoking during pregnancy is associated with airway inflammation and asthma in the offspring. It also increases the risk of impaired intrauterine growth and low birth weight. Low birth weight, in turn, is associated with decreased lung function independently of smoking.
In schoolchildren, the risk of physician-diagnosed asthma from smoking during pregnancy was increased sixfold in low birth weight children compared with children born at normal weight. Likely, smoke-induced airway infammation elicits obstructive symptoms more easily in children with underdeveloped airways.
Risk of Asthma in Young Adults Who Were Born Preterm: A Swedish National Cohort Study
Preterm birth is associated with chronic lung disease in infancy and asthma-like symptoms in later childhood. The longer-term risk of asthma in children born preterm, however, is unclear and increasingly relevant as larger numbers of these individuals are entering adulthood.
This is the first study with sufficient statistical power to evaluate asthma risk in young adults born extremely preterm. Extreme, but not later, prematurity is identified as a new, potentially important risk factor for asthma, at least into young adulthood.
Needle-Entry Angle for Lumbar Puncture in Children as Determined by Using Ultrasonography
Ultrasound has been used to characterize the depth and width of the interspinous space. A study by Abo et al found that the maximum width of the interspinous space is in the sitting position with flexed hips.
This study further characterizes the interspinous space by describing the optimal angle at which to point the needle. We found that the optimal angle for performing a lumbar puncture is ∼50° in infants and 60° in children aged 1 to 12 years.
Iron-Deficiency Anemia in Infancy and Social Emotional Development in Preschool-Aged Chinese Children
Preschool follow-up studies of children who had chronic, severe iron deficiency in infancy have revealed that these children have poorer cognitive and motor development and lower levels of alertness, physical activity, positive affect, and verbalization than children with good iron status in infancy.
This study was an investigation of whether nonanemic preschool-aged children who had chronic iron-deficiency anemia in infancy would show altered affect and behavior compared to children who were nonanemic throughout infancy.
The Influence of Family Characteristics on Perinatal Decision Making
Although the best-interest standard is considered to be the paradigm for decision making for the extremely preterm infant, caregivers are prepared to give, or withhold, active care against their own evaluation of a baby's best interest.
Evaluation of a baby's best interest, willingness to intervene actively or not, and compliance with parental wishes varied according to the age and socioeconomic status of the parents.
Effect of Liposomal Lidocaine and Sucrose Alone and in Combination for Venipuncture Pain in Newborns
Sucrose has been shown to reduce pain responses in infants undergoing venipuncture. The relative and combined effectiveness of sucrose and liposomal lidocaine, however, have not been previously evaluated.
Results of this study indicate that sucrose was more effective than liposomal lidocaine and that liposomal lidocaine did not confer any analgesic benefit when added to sucrose.
Adolescent Alcohol and Tobacco Use and Early Socioeconomic Position: The ALSPAC Birth Cohort
Much health-related behavior is socially stratified; people in lower socioeconomic groups report fewer “healthy” patterns. The relationship between socioeconomic position and tobacco smoking among adolescents is rarely an exception, whereas that with alcohol use is often inconsistent.
Alcohol use was more common among adolescents aged 13 years from higher-income households, whereas both alcohol and tobacco use were negatively associated with maternal education, which reflects how different aspects of socioeconomic position may influence health behaviors in opposite directions.
Bone Loss in Adolescents After Bariatric Surgery
The rate of bariatric surgery in teenagers is increasing rapidly, but little is known about its effects on bone health in such a young population.
Adolescents will lose some bone density in the first 2 years after bariatric surgery, but the z score does not typically fall below average for age and gender.
The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals
It is well established that risk factors such as maternal depression are prevalent and jeopardize children's health and development. Pediatric primary care offers an opportunity for helping address such psychosocial problems that are connected with child abuse and neglect.
Results of this study indicate that the Safe Environment for Every Kid model helps pediatric health professionals address targeted psychosocial problems. The study is one of the first to examine change in pediatric private practices concerning the management of psychosocial problems.
A Study of Burn Hospitalizations for Children Younger Than 5 Years of Age: 1983–2008
Burn injuries experienced by children are a leading cause of emergency department visits and hospitalizations and are often associated with significant physical and psychological long-term consequences and long-term medical and nursing treatments.
Admission rates for burn injury declined in the period of 1983–2008 in Western Australia. More than half of the admissions were for scald burns. The number of hospitalizations declined for scald, flame, contact, and electrical burns but increased for chemical burns during the study period.
Blood Pressure Percentiles by Age and Height From Nonoverweight Children and Adolescents in Germany
Current pediatric US blood pressure references are widely used internationally because of scarce international data and rare percentile derivation by age and height simultaneously. However, the US references may not fit other populations, and improved statistical methods have become available.
The German blood pressure references by age and height from nonoverweight children and adolescents aged 3 to 17 years use a national sample, oscillometric measurements validated in children, and improved statistical methods. These references were not influenced by the increasing prevalence of overweight children in the sample.
Cost Comparison of Baby Friendly and Non–Baby Friendly Hospitals in the United States
The slow adoption of Baby-Friendly Hospital Initiative standards in the United States has been largely attributed to the barrier of paying for formula in hospitals. Little is known about the true cost differences between Baby Friendly and non-Baby Friendly hospitals.
This study adds to the literature by calculating the average cost differences between Baby Friendly and non-Baby Friendly hospitals in the US. Baby Friendly hospitals do not have significantly higher labor and delivery costs than non-Baby Friendly hospitals.
Nutrient Enrichment of Mother's Milk and Growth of Very Preterm Infants After Hospital Discharge
Very preterm infants are often discharged before they reach term, and at the time of discharge many have not achieved catch-up growth. Mother's milk is recommended but might not meet the needs of the growing preterm infant after discharge.
Fortification of mother's milk while breastfeeding her very preterm infant after hospital discharge is possible without influencing breastfeeding duration. The amount of fortification given in this study did not improve growth at 1 year of age compared with unfortified mother's milk.
The Process of End-of-Life Decision-Making in Pediatrics: A National Survey in the Netherlands
Studies within neonatology and pediatric critical care have revealed that physicians consider it important to share end-of-life decisions with parents and to take sufficient time to resolve conflicts. How shared decision-making evolves in everyday practice is not yet known.
Within Dutch pediatrics, end-of-life decisions are team decisions. The level of parental involvement varies greatly depending on type of decision and type and duration of treatment. Conflicts within the medical team and between parents and team occur regularly.
Bereaved Parents' Perceptions of the Autopsy Examination of Their Child
Anecdotal and empirical literature on autopsy examination emphasizes the benefits for grieving families of a loved one's autopsy. Pediatric autopsy has previously been viewed as a particular mechanism to resolve parental grief.
The value of the autopsy in providing information that parents may use in their ongoing processing of grief and as an opportunity for an act of altruism was confirmed. Parents may hold mixed perceptions about a child's autopsy examination. Specific benefits and limitations of the autopsy for grieving parents are identified.
Metabolic Profiles in Children During Fasting
Hypoglycemia is one of the most common metabolic derangements in childhood. To establish the cause of hypoglycemia, fasting tolerance tests can be used. However, thus far, available reference values for fasting tolerance tests have limitations.
The present study provides age-dependent reference values of metabolites and glucoregulatory hormones during fasting in children. These reference values can be used to determine whether a child is at high risk for developing early hypoglycemia. For these high-risk children, guidelines concerning maximum fasting time and dietary interventions during illness are of utmost importance.
Carbon Dioxide and Glucose Affect Electrocortical Background in Extremely Preterm Infants
Both high and low Paco2 and plasma glucose levels, respectively, are associated with brain damage in preterm infants. Little is known about carbon dioxide and glucose effects on electrocortical activity in extremely preterm infants.
Moderate changes in Paco2 and plasma glucose levels influenced electroencephalogram continuity and power in extremely preterm infants. The long-term effects on brain function from variations in Paco2 and glucose levels need to be explored.
Recognizing Hypoglycemia in Children Through Automated Adverse-Event Detection
Automated adverse-event detection using triggers derived from the electronic health record is an efficient method of identifying adverse events, including hypoglycemia. However, there has been limited investigation using this system to detect adverse events in hospitalized children.
Hypoglycemia is common in hospitalized children, particularly neonates and those receiving insulin therapy. An electronic health record–driven automated adverse-event detection system was effective in identifying hypoglycemia in this population and will augment the safety programs of organizations that have adopted the electronic health record.
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- Copyright © 2011 by the American Academy of Pediatrics