Adolescent ADHD and Adult Physical and Mental Health, Work Performance, and Financial Stress
There are a few longitudinal studies that suggest that attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with later psychiatric disorders, substance use disorders, and impaired work performance.
Adolescent ADHD is associated with a variety of internal and external stresses in adulthood. Consequently, it is essential to focus intervention efforts on adolescents with ADHD to prevent or alleviate adult difficulties in functioning.
Dietary Salt Intake, Sugar-Sweetened Beverage Consumption, and Obesity Risk
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.
Association of Nutrient-Dense Snack Combinations With Calories and Vegetable Intake
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.
Effectiveness of Developmental Screening in an Urban Setting
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.
Part C Early Intervention for Infants and Toddlers: Percentage Eligible Versus Served
Part C early intervention serves ∼2.8% of US children who are younger than 3 years old; however, there is evidence that substantial numbers of infants and toddlers with developmental delays receive no early intervention services.
Broad eligibility criteria can classify children who have no delays or minimal delays as candidates for Part C services. Despite this, no jurisdiction provides Part C services to all children who have substantial delays.
Effects of Iron Supplementation of LBW Infants on Cognition and Behavior at 3 Years
Low birth weight (LBW) infants (<2500 g) are at risk for cognitive and behavioral problems later in life. During infancy, they are also at risk for iron deficiency, which has been associated with impaired neurodevelopment in other high-risk groups.
Iron supplementation during the first 6 months of life to LBW infants reduces the risk of behavioral problems at 3.5 years. Mild iron deficiency in infancy may be an important, preventable contributor to behavioral problems in children born with LBW.
Maternal Prepregnancy BMI and Child Cognition: A Longitudinal Cohort Study
Maternal obesity is an increasingly important public health concern and may adversely affect central nervous system development in offspring. However, few studies have explored the relationship between maternal prepregnancy BMI and neurodevelopmental outcomes in children, with conflicting results.
Using data from a large and contemporary UK birth cohort, we found that maternal prepregnancy BMI is negatively associated with children’s cognitive performance. The relationship appears to become stronger as children get older, although the overall effect size is modest.
Medical Home Quality and Readmission Risk for Children Hospitalized With Asthma Exacerbations
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.
Longitudinal Associations Between Teen Dating Violence Victimization and Adverse Health Outcomes
Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.
This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims.
Nonsteroidal Antiinflammatory Drugs in Late Pregnancy and Persistent Pulmonary Hypertension of the Newborn
Knowledge is limited regarding the epidemiology of persistent pulmonary hypertension of the newborn (PPHN). Previous work has implicated a host of perinatal risk factors and a few antenatal antecedents of PPHN, including maternal consumption during pregnancy of nonsteroidal antiinflammatory medications.
In contrast to results of previous studies, we found no association between PPHN and maternal consumption during late pregnancy of nonsteroidal antiinflammatory drugs in general or ibuprofen in particular.
Weight-Based Victimization: Bullying Experiences of Weight Loss Treatment–Seeking Youth
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.
Child and Parental Reports of Bullying in a Consecutive Sample of Children With Food Allergy
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.
Trends and Socioeconomic Correlates of Adolescent Physical Fighting in 30 Countries
Adolescent physical fighting is an important public health concern with known social origins. However, existing international studies of adolescent fighting provide little evidence about its prevalence, trends over time, or possible socioeconomic determinants.
We studied frequent physical fighting among 494 874 adolescents in 30 countries over an 8-year period. Physical fighting declined in most countries. National measures of absolute wealth but not socioeconomic inequalities related to risk of frequent physical fighting.
Trends in Survival Among Children With Down Syndrome in 10 Regions of the United States
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.
Use and Accuracy of Diagnostic Imaging by Hospital Type in Pediatric Appendicitis
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.
Diagnostic Imaging Studies Performed in Children Over a Nine-Year Period
Medical imaging that uses ionizing radiation provides notable benefits in the clinical setting. Controversy regarding increased cancer risk, particularly in children, dictates that ordering practices and use of such medical imaging be evaluated to reduce unnecessary exposure to imaging-related radiation.
We evaluated the prevalence and characteristics of diagnostic imaging procedures in children. The proportion of higher radiation procedures is increasing, especially among children evaluated in the inpatient and emergency department settings and those with gastrointestinal and neurologic symptoms, and congenital anomalies.
In Utero Exposure to Ischemic-Hypoxic Conditions and Attention-Deficit/Hyperactivity Disorder
Although previous studies indicate that perinatal factors are associated with altered neurodevelopment, data on the association between ischemic-hypoxic conditions and attention-deficit/hyperactivity disorder in children are sparse.
This study demonstrates that preeclampsia, birth asphyxia, and respiratory distress syndrome are independently associated with increased risk of attention-deficit/hyperactivity disorder in a large population-based study.
Lifetime Growth and Blood Pressure in Adolescence: Hong Kong’s “Children of 1997” Birth Cohort
Most observational studies from Western populations suggest that blood pressure is positively associated with low birth weight and faster infant growth; however, it is unclear whether these associations are biologically based or contextually specific.
In a developed non-Western setting with relatively little socioeconomic patterning of size or growth, birth weight and infant growth had relatively limited impacts on early adolescent blood pressure, which was more strongly related to recent growth and current size.
Subclinical Cerebral Edema in Children With Diabetic Ketoacidosis Randomized to 2 Different Rehydration Protocols
Cerebral edema (CE) occurs frequently during treatment of diabetic ketoacidosis (DKA) in children. Severe, life-threatening CE occurs rarely, but subclinical CE is common. Whether the rate of infusion of intravenous fluids influences the occurrence or severity of CE is unknown.
This study demonstrates that the rate of fluid infusion in children with DKA does not substantially affect MRI measures of CE. Studies assessing measures other than edema formation are necessary to determine whether fluid infusion rates influence DKA-related brain injury.
Physical Activity During School in Urban Minority Kindergarten and First-Grade Students
Physical inactivity is one of the major modifiable factors contributing to the growing national epidemic of childhood obesity. There is lack of literature on pedometer-determined physical activity (PA) during the school day in US minority kindergarten and first-grade students.
This is the first study to assess school-day PA in US urban minority kindergarten and first-grade students. Higher grade level, participation in physical education class, and outdoor recess were found to be independent predictors of PA.
Influence of Tobacco Displays and Ads on Youth: A Virtual Store Experiment
Youth exposure to retail tobacco advertisements and displays is associated with smoking initiation. The Family Smoking Prevention and Tobacco Control Act of 2009 gives states and local governments legal authority to regulate the time, place, and manner of tobacco advertising.
This is the first experimental study using a virtual store environment to provide evidence that a policy banning tobacco product displays at the point of sale may deter youth from attempting to purchase tobacco products at retail stores.
Validation of a Migraine Interview for Children and Adolescents
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.
Trends in Adverse Reactions to Trimethoprim-Sulfamethoxazole
Antimicrobials are a medication class frequently implicated in pediatric adverse drug reactions (ADRs). Trimethoprim-sulfamethoxazole (TMP-SMX) is long recognized as a contributor to the burden of these undesired and unpredictable events.
TMP-SMX ADRs increased from 2000 to 2009, with the majority of children taking the antibiotic for skin and soft tissue infections. The significant increase in TMP-SMX prescribing for these infections may result in a continued increase of associated ADRs.
Development at Age 36 Months in Children With Deformational Plagiocephaly
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.
Readability, Suitability, and Characteristics of Asthma Action Plans: Examination of Factors That May Impair Understanding
National asthma treatment guidelines include the recommendation that all asthma patients receive a written asthma action plan. No previous study has sought to examine the readability, suitability, and content of asthma action plans within a nationally representative sample.
Although variability was found across written asthma action plans, and improvements in readability, suitability, and content are needed, there were also many common elements that would support a move to a single universal standard action plan.
Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence
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.
Correlation of Care Process Measures With Childhood Asthma Exacerbations
Asthma is a common focus of pediatric quality improvement efforts. Various processes of care have been postulated as markers of high-quality pediatric asthma care, but it is not clear which processes correlate with a lower risk of asthma exacerbations.
This study analyzed the correlation of processes of care identifiable through administrative data with asthma exacerbations. The use of 0 vs ≥1 controller medications and the asthma medication ratio had the strongest correlation with asthma exacerbations.
The Relationship Between Cow’s Milk and Stores of Vitamin D and Iron in Early Childhood
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.
Prevalence of Vitamin D Deficiency Among Overweight and Obese US Children
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.
Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial
Obesity is a risk factor for failure to initiate breastfeeding, formula supplementation, and short breastfeeding duration. There is a need for interventions that can improve the breastfeeding outcomes of overweight and obese women.
Breastfeeding peer counseling targeting overweight/obese women did not affect exclusive breastfeeding rates or breastfeeding continuation beyond 2 weeks. However, the intervention was associated with improvements in early breastfeeding intensity and fewer infant hospitalizations in the first 6 months after birth.
Preventability of Early Readmissions at a Children’s Hospital
There is widespread belief that many hospital readmissions in adults are avoidable by improvements in care and discharge planning processes, resulting in significant cost savings; however, current studies have not examined the preventability of such readmissions in children’s hospitals.
The overall rate of pediatric 15-day readmissions considered to be preventable was low, less than 2% of total hospital admissions. Pediatric readmissions are unlikely to serve as a highly productive focus for cost savings or quality measurement.
Socioeconomic Status and In-Hospital Pediatric Mortality
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.
Near-Infrared Imaging in Intravenous Cannulation in Children: A Cluster Randomized Clinical Trial
Gaining intravenous access in children can be difficult. Recently, several near-infrared devices have been introduced attempting to support intravenous cannulation by visualizing veins underneath skin. Only one of those devices has been evaluated systemically thus far and results are inconclusive.
Although it was possible to visualize veins with near-infrared in most patients, the VascuLuminator did not improve the success of cannulation. An explanation is that the main problem is probably not localization of the vein but insertion of the cannula.
A Randomized Trial of Stylets for Intubating Newborn Infants
Endotracheal intubation of newborn infants is a common procedure. Competency in this skill is mandatory for many pediatric training programs. The safety and benefits of using a stylet for intubating newborn infants are unknown.
Pediatric trainees are commonly unsuccessful at performing endotracheal intubation. Adverse events of using a stylet are uncommon. The use of a stylet does not increase success rates.
Physical Disability After Injury-Related Inpatient Rehabilitation in Children
Outcomes analyses after trauma reveal long-term disability but are limited to specific injuries, older data, or all ages combined. There are no contemporary assessments of physical disability among children after inpatient rehabilitation for a wide range of traumatic injuries.
This is the first contemporary study to describe the physical disability of a large pediatric cohort after inpatient rehabilitation for various injuries. After a mean 21-day inpatient rehabilitation stay, significant reductions in functional disability were achieved across injury mechanisms.
Changes in Metabolic Syndrome in American and Korean Youth, 1997–2008
In the United States, adolescent obesity rates have tripled in the last 3 decades, with concomitant increases in other metabolic risk factors, including the metabolic syndrome (MetSyn). However, in Asian countries, these same risks have only recently begun increasing.
Representative data for the United States and Korea reveal trends in adolescent obesity and MetSyn moving in opposite directions. This study provides a benchmark for Korea and other Asian countries toward mitigating the upward trends in obesity and MetSyn.
Obtaining Consent from Both Parents for Pediatric Research: What Does “Reasonably Available” Mean?
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.
Detection of Kingella kingae Osteoarticular Infections in Children by Oropharyngeal Swab PCR
There is evidence that Kingella kingae, the major bacterial cause of osteoarticular infection in children <4 years of age, first colonizes the oropharynx before penetrating the bloodstream and invading distant organs. Diagnosis remains challenging because clinical findings at admission may be normal.
Our study demonstrated for the first time that a simple technique of detecting of K kingae DNA in the oropharynx can provide strong evidence that this microorganism is responsible for the OAI, or even stronger evidence that it is not.
Growth in Children With Congenital Heart Disease
Children with congenital heart disease (CHD) are at increased risk for poor growth. Several factors may play a role in poor growth, including feeding difficulties, increased caloric requirements, and the effects of cardiac lesions on growth regulation.
In children with CHD, impaired growth as measured by weight, length, and head circumference occurs simultaneously rather than sequentially, supporting the theory that altered growth regulation likely plays an important role in the poor growth of children with CHD.
Self- and Parent-Rated Executive Functioning in Young Adults With Very Low Birth Weight
Very low birth weight (VLBW; <1500 g) subjects show lower scores in performance-based tests of executive functioning (EF) than control subjects up to young adulthood.
VLBW adults’ perceptions of their EF in everyday life are very similar to those of term-born adults. Parental evaluation of VLBW/small-for-gestational-age adults’ EF is more negative than adults’ self-reports.
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- Copyright © 2013 by the American Academy of Pediatrics