US Prevalence and Trends in Tobacco Smoke Exposure Among Children and Adolescents With Asthma
Among youth with asthma, tobacco smoke exposure causes increased asthma morbidity. Little is known about changes over time in tobacco smoke exposure among youth with asthma in a national sample.
Our analysis reveals a decrease in environmental tobacco smoke exposure among children and adolescents with current asthma in the United States from 1988–1994 to 2005–2010, but a majority of youth with asthma remain exposed to environmental tobacco smoke.
Practices of Unregulated Tanning Facilities in Missouri: Implications for Statewide Legislation
UV radiation exposure in tanning beds is associated with an increased risk of skin cancer. Because of the rising rate of melanoma, the World Health Organization recommends that persons <18 years of age not use tanning devices.
Despite scientific evidence to the contrary, tanning facilities in Missouri, a state without indoor-tanning regulations, often misinformed consumers regarding the risk of skin cancer and would allow children as young as 10 years old to use tanning devices.
Developmental Trends in Peer Victimization and Emotional Distress in LGB and Heterosexual Youth
Peer victimization predicts numerous health risks. Lesbian, gay, and bisexual (LGB)-identified youth report greater peer victimization than do heterosexual-identified youth. No longitudinal studies have been conducted on developmental trends of peer victimization and emotional distress among LGB and heterosexual youth.
We provide the first longitudinal evidence on developmental trends of peer victimization and emotional distress for LGB- and heterosexual-identified youth. The findings suggest peer victimization of LGB-identified youth decreases in absolute, but not necessarily relative, terms and contributes to later emotional distress disparities.
Modifying Media Content for Preschool Children: A Randomized Controlled Trial
Children have been shown to imitate behaviors they see on screen.
Modifying what children watch can improve their observed behavior.
Disparities in Transition Planning for Youth With Autism Spectrum Disorder
Health care transition services assist youth with special health care needs (YSHCN) in transitioning to adult care without gaps in services or health insurance coverage. Less than half of YSHCN receive anticipatory assistance in this transition; receipt of these services for youth with autism spectrum disorder is unknown.
Youth with autism spectrum disorder receive transition services half as often as youth with special health care needs. Quality of health care is associated with increased receipt of health care transition services. Presence of comorbid conditions decreased receipt of transition services.
Chronic Conditions Among Children Investigated by Child Welfare: A National Sample
Most studies focus on health of foster children or local samples of young children. One previous study examined a national cohort longitudinally but did not address the full age group or range of conditions at the time of initial investigation.
Using 2 approaches to assess children (aged 0–17.5 years) who have chronic health conditions, we found that regardless of placement, investigated children had much higher rates of these conditions than the general population at the time of initial assessment.
Associations of Food Stamp Participation With Dietary Quality and Obesity in Children
The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. Studies among adults suggest that SNAP participation may be associated with suboptimal diets. Few studies have extensively examined these associations among children.
SNAP participation was not associated with childhood obesity. SNAP children consumed diets poorer in some aspects than nonparticipants, but intake of some micronutrients was higher. The diets of both groups of low-income children were far from meeting dietary guidelines.
Readiness of Primary Care Practices for Medical Home Certification
Practice characteristics, such as practice size, have been associated with the readiness of adult primary care practices for medical home certification. Little is known about how ready primary care practices for children are for medical home certification.
Primary care practices for children attained only 38% of the infrastructure required for medical home certification. Smaller practice size was significantly associated with lower infrastructure scores. Medical home programs need effective approaches to support practices with limited resources.
Potential Sources of Bisphenol A in the Neonatal Intensive Care Unit
Bisphenol A (BPA) is an environmental endocrine disruptor that can leach from polycarbonate plastics and epoxy resins, leading to widespread exposure. Fetal and early postnatal periods are particularly vulnerable to exposure to BPA.
This study identified medical devices as a potential source of exposure to BPA among premature infants in the NICU, even when efforts to reduce polycarbonate plastics were taken.
Different Guidelines for Imaging After First UTI in Febrile Infants: Yield, Cost, and Radiation
There is a lack of consensus regarding the optimal investigative approach after a first febrile urinary tract infection. This is because of uncertainty regarding the long-term clinical significance of vesicoureteral reflux and urinary tract infection–related renal scarring.
No ideal diagnostic algorithm exists. We found marked variability in sensitivity and specificity for detection of abnormalities using current protocols. We also highlight the considerable cost differences, both financially and in terms of radiation dose, of different protocols.
The Utility of Follow-up Skeletal Surveys in Child Abuse
Follow-up skeletal surveys are conducted commonly in children with suspected physical abuse, despite limited evidence. Different guidelines recommend follow-up skeletal surveys in children with abnormal initial skeletal surveys or in cases with high risk.
Across several centers, follow-up skeletal surveys revealed new information in >20% of cases and frequently affected the perceived likelihood of abuse, even in cases where the initial level of concern for abuse was moderate.
Cardiometabolic Risk Factors Among US Adolescents and Young Adults and Risk of Early Mortality
The presence of elevated cardiometabolic risk factors, such as obesity, high glucose or lipid levels, and smoking, in adolescents has been shown to be associated with earlier onset of chronic conditions, such as diabetes and heart disease.
Obesity, smoking, and elevated glucose increases the risk of dying before the age of 55 years. This is the first study to focus on risk factors and mortality among adolescents and young adults in a nationally representative US sample.
Prevalence of Childhood Celiac Disease and Changes in Infant Feeding
Celiac disease is increasing in several countries and has emerged as a public health problem. Infant feeding has been suggested to affect celiac disease development and/or clinical expression. However, evidence-based complementary feeding strategies are limited.
Significant difference in celiac disease prevalence between 2 cohorts of 12-year-olds indicates an option for disease prevention. The cohorts differed in infant feeding, and our findings suggest that gradual introduction of gluten in small amounts during ongoing breastfeeding is favorable.
Distinguishing Lyme From Septic Knee Monoarthritis in Lyme Disease–Endemic Areas
Children with Lyme and septic arthritis of the knee may present similarly, although septic arthritis requires prompt treatment initiation to avoid joint destruction. Clinicians must make initial management decisions without Lyme serology and bacterial culture results.
Our clinical prediction rule accurately identified patients at low risk for septic arthritis in a Lyme disease–endemic area. In the appropriate clinical context, low-risk patients may be spared invasive testing such as diagnostic arthrocentesis.
School Environment and Adolescent Depressive Symptoms: A Multilevel Longitudinal Study
Research indicates that adolescents who perceive their school to have a positive socioeducational environment are at reduced risk of developing depressive symptoms. However, there is limited evidence that school environments can influence adolescent emotional health independently from individual perceptions.
This multilevel longitudinal study shows that better school socioeducational environments, as assessed at the school level, reduce the prospective risk of depressive symptoms in adolescents. This association is shown to be independent from confounders and stronger in girls than boys.
Cost-Effectiveness of the School-Based Asthma Therapy (SBAT) Program
Urban children suffer disproportionately from asthma, and suboptimal treatment with preventive medications is common. Although several programs have been developed to reduce morbidity for urban children with asthma, their economic feasibility and sustainability remain unknown.
Our study demonstrates that the school-based asthma therapy program could be an economically effective program for children aged 3 to 10 years attending preschool or elementary school in a city school district, at the cost of $10/symptom-free day.
Trends in Resource Utilization for Hospitalized Children With Skin and Soft Tissue Infections
Skin and soft tissue infections (SSTIs) are a common pediatric condition often requiring inpatient management. Several studies describe recent increases in hospitalizations due to SSTIs.
In addition to rising hospitalizations, analysis of pediatric SSTI resource utilization trends revealed a twofold increase in incisions and drainages over a 13-year period. A growing number of incisions and drainages were performed in younger children.
Reasons for Earlier Than Desired Cessation of Breastfeeding
Reasons mothers cite for breastfeeding cessation vary across an infant's first year of life; however, once women stop breastfeeding, little is known about whether they breastfed as long as they desired or reasons why they did not meet their desired duration.
About 60% of mothers do not meet their desired breastfeeding duration. Mothers who do not breastfeed as long as they desire primarily cite concerns about maternal or child health and processes associated with breastfeeding as their reason to stop breastfeeding.
Voice Abnormalities at School Age in Children Born Extremely Preterm
Isolated case reports of abnormal voice after extremely preterm birth are well described; however, there are no systematic studies of long-term voice outcomes in children born preterm.
Significant voice abnormalities were found in more than half of tested children born before 25 weeks’ gestation. Multivariable analyses showed that the number of intubations, not the duration of intubation, and female gender were strongly associated with this adverse outcome.
Chronic Acetaminophen Exposure in Pediatric Acute Liver Failure
Children with acute liver failure due to a single-dose acetaminophen exposure have a characteristic liver biochemistry profile of low conjugated bilirubin and high alanine aminotransferase, which is associated with a favorable clinical outcome when treated with N-acetylcysteine.
Children with acute liver failure associated with chronic acetaminophen exposure also have a similar liver biochemistry profile, but for unknown reasons, they have a poorer clinical outcome than patients with single-dose acetaminophen exposure.
Working Memory Training Improves Cognitive Function in VLBW Preschoolers
Preterm born children have cognitive problems that include deficits in working memory. Computer-based working memory training has been reported to improve cognitive function in children.
A computer-based working memory training program designed for preschoolers seems effective in very low birth weight children, not only on working memory tasks, but also by having a generalizing effect regarding memory and learning.
Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China
In humans, the brain growth spurt begins in the last trimester of pregnancy and extends through the first 2 years of life. Studies show poor cognitive and motor development among children who have iron deficiency anemia in infancy.
Prenatal iron deficiency anemia in the third trimester affects child mental development. Prenatal micronutrient supplementation with sufficient iron protects child mental development even when the woman’s iron deficiency anemia is not properly corrected during pregnancy.
Practical Community Photoscreening in Very Young Children
Amblyopia affects 2% to 4% of the US population and is preventable In January 2011, the US Preventive Services Task Force concluded there is insufficient evidence to support vision screening in children younger than age 3 years.
Results of the Iowa photoscreening program in 210 695 children older than 11 years suggest photoscreening reliably detects amblyogenic risk factors in children 1 to 3 years of age, and we recommend photoscreening children starting at 1 year of age.
Maternal Alcohol-Use and Sudden Infant Death Syndrome and Infant Mortality Excluding SIDS
Reductions in infant mortality in the 20th century have not continued. Racial and socioeconomic inequalities in both infant mortality and sudden infant death syndrome (SIDS) persist. Rates of infant mortality in English-speaking countries are higher than the Organisation for Economic Co-operation and Development average.
At least 16.4% of SIDS and 3.4% of infant deaths not classified as SIDS are attributable to maternal alcohol use. Maternal alcohol-use disorder increases the risk of infant mortality through direct effects on the fetus and indirectly through environmental risk factors.
Facial Dysmorphism Across the Fetal Alcohol Spectrum
Prenatal alcohol exposure causes a continuum of effects. The most severe phenotype, fetal alcohol syndrome, involves facial dysmorphism, growth deficits, and neurocognitive problems. The classic facial characteristics include short palpebral fissures, smooth philtrum, and thin upper vermillion.
This study develops novel strategies to help detect facial dysmorphism across the fetal alcohol spectrum, especially in children with heavy alcohol exposure but without classic facial characteristics. The methods show potential for identifying which of these children are cognitively affected.
Computer-Generated Reminders and Quality of Pediatric HIV Care in a Resource-Limited Setting
Of more than 2 million children infected with HIV, almost 90% live in resource-limited settings where pediatric HIV care is often suboptimal. Implementing electronic health records with computerized decision support offers a potential tool for improving care.
This randomized, controlled trial demonstrates that computer-generated clinical reminders can significantly improve clinician compliance with HIV care guidelines for children in a resource-limited setting. This intervention is scalable as developing countries implement electronic health record systems.
Chest Compression Quality Over Time in Pediatric Resuscitations
Rapid initiation of effective chest compressions (CCs) for patients in cardiac arrest improves outcomes, yet even trained rescuers fail to provide consistently effective CCs. Pediatric data on CC quality and objective measures of CC work are limited.
CC quality deteriorates similarly in pediatric and adult models, and overall work done to compress the pediatric chest is similar to that in adults. Power output during CC performance is analogous to that generated during intense exercise such as running.
Increased Length of Stay and Costs Associated With Weekend Admissions for Failure to Thrive
Failure to thrive (FTT) is a common and vexing pediatric problem. Evaluation has historically involved large batteries of tests, multiple consultations, radiologic studies, and prolonged hospital admissions, resulting in significant costs and inconsistent results.
Scheduled failure to thrive (FTT) admissions on weekends result in increased lengths of stay and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs.
Interns' Success With Clinical Procedures in Infants After Simulation Training
Pediatric training programs use simulation for procedural skills training. Research demonstrates student satisfaction with simulation training, improved confidence, and improved skills when retested on a simulator. Few studies, however, have investigated the clinical impact of simulation education.
This is the first multicenter, randomized trial to evaluate the impact of simulation-based mastery learning on clinical procedural performance in pediatrics. A single simulation-based training session was not sufficient to improve interns’ clinical procedural performance.
Level of Trainee and Tracheal Intubation Outcomes
Provider training level is associated with lower rates of successful tracheal intubation in selected neonatal settings. However, little is known about the association of training level with tracheal intubation success and adverse events in the PICU.
Our results demonstrate the association of training level on the first attempt and overall success rate as well as the incidence of adverse tracheal intubation–associated events in a large-scale, prospective assessment across 15 academic PICUs.
A Novel Multispecialty Surgical Risk Score for Children
Current measures of risk stratification in the pediatric surgical literature are specialty specific. Although these risk scores have been validated as useful predictors of adverse outcomes, no measures currently exist to assess the full spectrum of pediatric surgery.
Our study generates a multispecialty mortality risk score for pediatric surgical patients that can be used by physicians to identify high-risk patients as well as provide a measure of risk adjustment for surgical outcomes.
Retrospective Evaluation of a New Neonatal Trigger Score
Trigger scores and early warning systems provide an objective measure of a patient’s condition, allowing earlier recognition of severe illness and adaptation of care. Such scores are established in adult and pediatric populations but remain unevaluated and rarely used in neonates.
This newly designed Neonatal Trigger Score provides an objective adjunct to multidisciplinary clinical assessment in detecting unwell neonates. It is more sensitive and specific than previously validated pediatric early warning system scores.
Growth Outcomes of Weight Faltering in Infancy in ALSPAC
Studies of clinically derived samples of infants with failure to thrive have reported that children remain shorter and lighter than their peers at school-age. Enhanced weight gain (“catch-up”) in small infants has been linked to subsequent obesity.
Infants with early weight faltering caught up in weight by 2 years, but height gain remained disproportionally slow. Those with weight faltering later in infancy remained shorter and lighter throughout childhood. Anthropometric outcomes of both groups were within population norms at 13 years.
Sedentary Behavior and Physical Activity in Youth With Recent Onset of Type 2 Diabetes
The rise in type 2 diabetes in youth is a major public health concern thought to be partially due to decreasing activity levels and increasing obesity. The role of sedentary time as a possible contributor also needs to be examined.
Measured objectively, obese youth, with or without type 2 diabetes, spend little time in moderate to vigorous physical activity. Those with type 2 diabetes, however, were significantly more sedentary than their obese counterparts, identifying an important area for future intervention efforts.
Neonatal Visual Evoked Potentials in Infants Born to Mothers Prescribed Methadone
Impaired visual development has been reported in infants born to mothers prescribed methadone in pregnancy. Immature visual evoked potentials have been reported in this population, but data were confounded by gestation, growth restriction, and illicit drug use.
Visual evoked potentials are small and immature in infants exposed to methadone and other drugs of misuse in utero. These changes are independently associated with methadone exposure and persist after controlling for gestation, socioeconomic deprivation, alcohol consumption, and cigarette smoking.
Receive summaries of articles in each month's issue of Pediatrics when you sign up at www.pediatrics.org.
- Copyright © 2013 by the American Academy of Pediatrics