Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009
The first evaluation of the economic impact of all vaccines in the routine US childhood immunization schedule assessed the 2001 schedule (excluding pneumococcal conjugate and influenza vaccines) and documented substantial cost savings over the lifetimes of the cohort of children born in 2001.
This report updates our previous evaluation, and estimates the costs and benefits of vaccinating the cohort of children born in 2009. We include vaccines routinely recommended for children in 2009.
Ultrasonography/MRI Versus CT for Diagnosing Appendicitis
Previous studies have confirmed feasibility of MRI for diagnosis of appendicitis in adults and children. No study has assessed clinical end points when using ultrasound and MRI compared with computed tomography for diagnosis of appendicitis in children.
Radiation-free imaging with ultrasound selectively followed by MRI does not change clinical endpoints compared with CT for diagnosing appendicitis in children, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.
National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes
Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation.
Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients.
Common and Costly Hospitalizations for Pediatric Mental Health Disorders
The pediatric mental health burden is substantial, with >4 million children meeting criteria for a mental health disorder. Mental health is a key priority for national pediatric inpatient quality measures, but little is known about admitted patients and their diagnoses.
Nationally, nearly 10% of hospitalizations in children >3 years are for primary mental health diagnoses. The most common and costly are depression, bipolar disorder, and psychosis. Fewer free-standing children’s hospitalizations (3%) were for mental health admissions, although diagnostic distributions were similar.
Supplemental Nutrition Assistance Program Participation and Child Food Security
Recent studies have shown that participating in the Supplemental Nutrition Assistance Program (SNAP) is associated with improved household food security. With the exception of 1 descriptive analysis, studies have not examined how SNAP affects children’s food security.
This article estimates the association between SNAP and children’s food security using the largest, most rigorous national study of food security to date. Given current proposals to reduce program size, this study underscores SNAP’s importance in affecting children’s well-being.
Association Between Riding With an Impaired Driver and Driving While Impaired
Motor vehicle crashes, heavy drinking, and drug use are serious, interactive health concerns for the teenage population. Teenage alcohol-impaired driving behaviors are associated with heavy drinking, parenting practices, and exposure to drinking and driving.
Earliness of exposure to alcohol/drug impaired driving (DWI) and early licensure were independent risk factors for teenage DWI. A strong, positive dose-response existed between DWI and amount of prior exposure to DWI in the form of riding with an impaired driver.
Military Health Care Utilization by Teens and Young Adults
Adolescents and young adults consume a significant amount of health care resources in our current medical system. With the Patient Protection and Affordable Care Act, a much larger number of previously uninsured young adults (aged ≥19) will be covered.
The Military Health System provides valuable information about the health utilization patterns of adolescents and young adults (aged 12–22) with universal insurance and excellent access to care. This information may help us understand the impact of new health care legislation.
Use of Modified Acute Concussion Evaluation Tools in the Emergency Department
Concussions in youth are a common injury evaluated in the emergency department (ED). Early recognition and active management of this mild traumatic brain injury are important to safe recovery. Tools to assess and manage concussion in the ED are lacking.
Acute Concussion Evaluation tools, modified for ED use, improved reported follow-up with primary care or concussion specialists and adherence to recommendations. Barriers to follow-up remain and the importance of ongoing outpatient management should be stressed.
Postconcussive Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury
After mild traumatic brain injury, most youth recover well. A minority of patients report persistent symptoms, which relate to both injury and noninjury factors. In adult studies, validity test performance is 1 noninjury factor that relates to persistent symptoms.
This is the first pediatric study to demonstrate that validity test failure is associated with increased symptoms after mild traumatic brain injury. The findings suggest that some symptoms conceptualized as injury-related “postconcussive” problems are better explained by exaggeration or feigning.
Clostridium difficile Infection Among Children Across Diverse US Geographic Locations
Little is known about the epidemiology and pathogenicity of Clostridium difficile infection among children, particularly those aged ≤3 years in whom colonization is common and pathogenicity uncertain.
Young children, 1 to 3 years of age, had the highest Clostridium difficile infection incidence. Considering that clinical presentation, outcomes, and disease severity were similar across age groups, C difficile infection in the youngest age group likely represents true disease and not asymptomatic colonization.
Attention-Deficit/Hyperactivity Disorder in Young Children: Predictors of Diagnostic Stability
Approximately 50% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) at <7 years of age in the community do not meet criteria for ADHD over time. There is a need to examine predictors of diagnostic stability in young children with ADHD.
Predictors of diagnostic stability from early to middle childhood include child’s baseline externalizing and internalizing symptoms, parental history of psychopathology, and socioeconomic status. These predictors may guide treatment planning at the time of ADHD diagnosis.
Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory
Childhood attention-deficit/hyperactivity disorder has been associated with both childhood and adult obesity, whereas treatment with stimulants has been associated with delayed child growth. No longitudinal studies with details about dates of diagnosis, treatment, and duration of stimulant use have been published.
Using electronic health record data, this was the first study to evaluate the independent associations of attention-deficit/hyperactivity disorder diagnosis, stimulant treatment, age at first stimulant use, and duration of stimulant use on longitudinal BMI trajectories throughout childhood and adolescence.
Infant Sleep Machines and Hazardous Sound Pressure Levels
Many parenting Web sites encourage use of infant “sleep machines” to play ambient noise while infants sleep. Noise recommendations for hospital nurseries suggest a limit of 50 A-weighted dB, whereas occupational standards limit exposure times for noise >85 A-weighted dB.
We measured the maximum sound level outputs of infant sleep machines and found that several devices are capable of producing levels that may be damaging to infant hearing and may be detrimental to auditory development.
Parental Death During Childhood and Subsequent School Performance
Many children experience the death of a parent during childhood. The long-term consequences of this life event, including school performance, and the importance of the psychosocial circumstances of the home have not been well elucidated in previous studies.
Both maternal and paternal deaths during childhood were associated with lower grades and school failure. Many of the associations (and especially for death due to external causes) were associated with socioeconomic disadvantage and psychosocial problems in the family.
Pediatric Data Sharing in Genomic Research: Attitudes and Preferences of Parents
We previously reported that parents of children enrolled in genomic research made more restrictive data sharing (DS) decisions than adults. The ethics of pediatric DS have been discussed, but reasons for differences in decision-making have not been explored.
We present an empirically based discussion of attitudes toward and preferences for DS obtained from structured interviews of adult patients and parents of pediatric patients enrolled in genomic research studies. Parents expressed more concern about future risks than adult participants.
Office-Based Preventive Dental Program and Statewide Trends in Dental Caries
Guidelines recommend that primary care physicians provide preventive dental services to young children. Most state Medicaid programs reimburse physicians for providing fluoride varnish. Individual-level studies show that these services are effective in reducing caries-related treatments and costs.
Preventive dental services provided through a North Carolina Medicaid preventive dental program led to a reduction in dental caries among young children statewide. Programs targeting vulnerable populations through medical offices can reduce disparities in oral health among preschool-aged populations.
Effective Messages in Vaccine Promotion: A Randomized Trial
Maintaining high levels of measles-mumps-rubella immunization is an important public health priority that has been threatened by discredited claims about the safety of the vaccine. Relatively little is known about what messages are effective in overcoming parental reluctance to vaccinate.
Pro-vaccine messages do not always work as intended. The effectiveness of those messages may vary depending on existing parental attitudes toward vaccines. For some parents, they may actually increase misperceptions or reduce vaccination intention.
Patterns of Mobile Device Use by Caregivers and Children During Meals in Fast Food Restaurants
Mobile devices are ubiquitous in children’s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiver–child interactions, has not been studied.
In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction.
Thirdhand Smoke Beliefs of Parents
Little is known about how thirdhand smoke beliefs are related to smoking and quitting behaviors, and how parental smokers’ thirdhand smoke beliefs influence behaviors to protect children. A previous study suggests thirdhand smoke beliefs are associated with home smoking bans.
This is the first study to show that parents’ beliefs about thirdhand smoke are associated with multiple smoking-related attitudes and behaviors that affect the health of children.
Racial and Ethnic Differences Associated With Feeding- and Activity-Related Behaviors in Infants
Although expert consensus and previous literature document the importance of early feeding and activity behaviors and practices in preventing obesity and the risks of early rapid weight gain, few studies have rigorously assessed obesity-related behaviors by caregivers of infants.
This study demonstrates the high prevalence of behaviors thought to increase risk for obesity in a diverse, large sample of parent/2-month-old dyads and finds that many behaviors vary by race and ethnicity, suggesting the potential for culturally tailored interventions.
BMI, Health Behaviors, and Quality of Life in Children and Adolescents: A School-Based Study
Existing literature indicates relationships between BMI, physical activity, sleep patterns, eating behavior, and health-related quality of life in children and adolescents. However, many previous studies have used non–preference-based instruments, which are not suitable for application within economic evaluation.
The Child Health Utility 9D, a new preference-based health-related quality of life instrument for application in economic evaluation in children and adolescents, revealed stronger associations between utilities and sleep patterns or eating behavior than with BMI, physical activity, or sedentary behavior.
Impact of the FITKids Physical Activity Intervention on Adiposity in Prepubertal Children
Physical activity interventions aimed at improving body composition in childhood have had limited success and often targeted overweight children. Therefore, the efficacy of physical activity randomized controlled trials in improving body composition among children with varying adiposity levels remains unknown.
This randomized controlled trial demonstrated that a physical activity program designed to meet daily physical activity recommendations can improve cardiorespiratory fitness, decrease total fat mass, and prevent accumulation of central adiposity in a group of children with varying adiposity levels.
Health Inequalities in Urban Adolescents: Role of Physical Activity, Diet, and Genetics
Individuals living in Mediterranean countries have historically had a lower risk of cardiovascular disease. Important changes in diet and lifestyle have taken place in these countries in recent years, and it is unknown how these changes might influence current cardiovascular health.
Fitness and fatness levels indicate that urban adolescents from southern Europe are less healthy than those from central northern Europe. The extent to which these differences might be explained by physical activity, diet, and genetics is analyzed and discussed in this article.
Strength Capacity and Cardiometabolic Risk Clustering in Adolescents
Resistance exercise is known to have a robust effect on glycemic control and cardiometabolic health among children and adolescents, even in the absence of weight loss.
Normalized strength capacity is associated with lower cardiometabolic risk clustering in boys and girls, even after adjustment for cardiorespiratory fitness, level of physical activity, and BMI.
Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial
Diarrhea still remains as a significant cause of morbidity and mortality. Intervention to reduce this risk are needed. Evidence on the effect of Lactobacillus reuteri DSM 17938 to prevent diarrhea in children is scarce.
In healthy children attending day care centers, daily administration of L reuteri DSM 17938 had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infections, with consequent cost saving for the community.
Clinical Phenotype of Scabies by Age
Scabies is a frequent cause of consultation and has recently been classified as a neglected disease. The clinical presentation seems to be linked with age, although no specific study has aimed to delineate the clinical spectrum of scabies in infants and children.
Scabies in infants and children has distinct clinical features. This prospective observational study found that infants were more likely to have relapse, nodules, and to present involvement with extremities, face, and scalp, arguing for specific cares in this age group.
Ceftriaxone and Acute Renal Failure in Children
Ceftriaxone at therapeutic doses can lead to renal stone formation.
Renal stone formation with ceftriaxone therapy can result in postrenal acute renal failure in children. The condition can be treated effectively by timely pharmacotherapy or retrograde ureteral catheterization with good prognosis.
Seasonality of Asthma: A Retrospective Population Study
Asthma is a clinical condition treated mostly at primary care community clinics. Epidemics of asthma exacerbation occur annually with return to school after summer vacation and have been reported in many countries, including Israel.
In 82 234 asthmatic children, unscheduled primary care physician visits and drug prescriptions for asthma exacerbations peaked in September after a summer trough, with a lesser peak in late autumn and fluctuations through the winter months.
Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux
The familial nature of vesicoureteral reflux (VUR) is well recognized. Several studies have shown that siblings of children with VUR are at much higher risk for reflux than the general pediatric population with a reported prevalence between 26% and 50%.
There is increased risk of renal cortical abnormalities in siblings with a previous urinary tract infection, siblings with high-grade VUR, and siblings >1 year of age. This information may be useful when counseling parents about the risk of familial VUR.
Trends in the Prevalence of Ketoacidosis at Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study
Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prevalence of DKA at diagnosis was 25.5% in 2002–2003.
DKA in youth with type 1 diabetes remains a problem, with almost one-third presenting with DKA. Among youth with type 2 diabetes, DKA was less common and decreased by ∼10% per year, suggesting improved detection or earlier diagnosis.
Live Vaccine Use and Safety in DiGeorge Syndrome
Individuals with DiGeorge syndrome (DGS) have varying degrees of immunodeficiency. All are susceptible to vaccine-preventable infections with serious complications. Although live vaccines are generally contraindicated in this population, limited evidence suggests that they may be effective and safe for select individuals.
Many individuals with DGS received live vaccines despite having a known diagnosis. Adverse events following live immunizations were typically minor and self-limited, suggesting that live vaccines may be considered for patients with DGS who exhibit mild-to-moderate immunosuppression.
Free Thyroxine Levels After Very Preterm Birth and Neurodevelopmental Outcomes at Age 7 Years
Preterm infants have transiently lowered thyroid hormone levels during the early postnatal period. Past research suggests that low thyroid hormone levels are related to cognitive and developmental deficits in children born preterm.
Contrary to expectations, in this study of children born <30 weeks’ gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age.
Psychiatric Functioning and Quality of Life in Young Patients With Cardiac Rhythm Devices
Initial studies in children and young adults have identified higher levels of anxiety and lower quality of life scores in patients with implantable cardioverter–defibrillators. Few studies are available looking at the same questions in young patients with pacemakers.
Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation rather than type of device. Patients with pacemakers have depression and anxiety but at lower rates.
Activity Levels in Mothers and Their Preschool Children
Physical activity is beneficial to health. Parents are crucial in shaping children’s behaviors, with active mothers appearing to have active children. Little is known about this association in preschool-aged children, or about factors influencing activity in mothers of young children.
Mother-child physical activity levels were positively associated and influenced by temporal and demographic factors. Maternal activity levels were low, and influences differ by activity intensity. Health promotion efforts to increase activity in mothers may also benefit their young children.
Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial
Integrated or collaborative care intervention models have revealed gains in provider care processes and outcomes in adult, child, and adolescent populations with mental health disorders. However optimistic, conclusions are not definitive due to methodologic limitations and a dearth of studies.
This randomized trial provides further evidence for the efficacy of an on-site intervention (Doctor Office Collaborative Care) coordinated by care managers for children's behavior problems. The findings provide support for integrated behavioral health care using novel provider and caregiver outcomes.
Avoidable Hospitalizations in Youth With Kidney Failure After Transfer to or With Only Adult Care
The period of transition from childhood to adulthood and the period immediately after transfer of care is a challenging time for young people with kidney failure.
Young patients with kidney failure cared for exclusively in adult-oriented facilities experience increased rates of avoidable hospitalizations during late adolescence and young adulthood. Avoidable hospitalizations increased among pediatric kidney failure patients during the years immediately after transfer to adult care.
Prenatal Nutrient Supplementation and Postnatal Growth in a Developing Nation: An RCT
Prenatal lipid-based nutrient supplementation has been demonstrated to increase birth length. However, the impact of this intervention on infant growth and morbidity is unknown.
Infants from mothers who were given prenatal lipid-based nutrient supplements showed decelerated linear growth. The gain in length at birth related to prenatal lipid-based nutrient supplementation was not sustained during infancy.
The Epidemiology and Clinical Features of Kawasaki Disease in Australia
The incidence of Kawasaki disease is increasing in many countries. The only reported Australian incidence (3.4/100 000 <5 years) is almost 20 years old and the current Australian epidemiology and outcomes are unknown.
We analyzed 30 years’ total population hospitalization data from Western Australia. Kawasaki disease incidence increased markedly from 1979 to 2009 and is currently 9.34/100 000 <5 years. The epidemiology and cardiovascular outcomes are similar to other predominantly European-Caucasian populations.
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- Copyright © 2014 by the American Academy of Pediatrics