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Trends in Physical Activity, Sedentary Behavior,

Diet, and BMI Among US Adolescents, 2001

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2009

The prevalence of overweight and obesity in US adolescents has increased over the last century. However, recent evidence indi-cates a potential change in this trend. Parallel trends in adolescent behaviors that drive this epidemic have not been well studied.

Analyses of recent data indicate the prevalence of overweight and obesity may be stabilizing. Over the same period, ado-lescent physical activity, breakfast eating, and fruit and veg-etable consumption increased and television viewing and consumption of sweets and sweetened beverages decreased.

National Trends in Psychotropic Medication Use in

Young Children: 1994

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2009

Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, na-tionally representative investigations of US preschool psychotropic use.

In a national sample of 2 to 5 year olds, the likelihood of psy-chotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children, and those lacking private health insurance was documented.

Nonmedical Vaccine Exemptions and Pertussis in

California, 2010

Previous studies have shown that nonmedical exemptions (NMEs) to immunization cluster geographically and contribute

to outbreaks of vaccine-preventable diseases such as per-tussis. The 2010 pertussis resurgence in California has been widely attributed to waning immunity from acellular pertussis vaccines.

This study provides evidence of spatial and temporal clustering of NMEs and clustering of pertussis cases and suggests that geographic areas with high NME rates were also associated with high rates of pertussis in California in 2010.

Pediatric Mortality in Males Versus Females in the

United States, 1999

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2008

Adult males are known to have a greater overall likelihood of death than female adults. Among children, excess male mor-tality is known for speciﬁc conditions but not as a general phenomenon.

Males are more likely to die during childhood and adolescence than their female peers from not only injuries but also from a wide variety of medical conditions, suggesting the existence of either a female robustness factor or a male vulnerability factor.

Risk of Suicide Attempt in Adopted and Nonadopted

Offspring

Adoptees living in Sweden are at increased risk of suicide attempt compared with nonadopted individuals, although factors mediating this risk are largely unknown. Whether adoption status represents a risk for adoptees living in the United States remains unresolved.

The odds for reported suicide attempt are elevated in US adoptees relative to nonadoptees, theﬁrst demonstration of

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More than 70% of all preterm deliveries are late-preterm (34–36 weeks of gestation). Compared with those born at term, those born late-preterm have higher risk for medical and neurodevelopmental disabilities and suffer more often from mental and behavioral problems.

Late-preterm birth is associated with considerable lifetime socioeconomic disadvantages across the adult years. These disadvantages are not explained by childhood parental so-cioeconomic position.

A Longitudinal View of Child Enrollment in Medicaid

Cross-sectional estimates suggest that one-third of children are enrolled in Medicaid or other public insurance programs. The percentage of children enrolled in Medicaid at any point during childhood, and which children use Medicaid as a longer-term insurance source, is unknown.

Over a 5-year period, 41% of children were enrolled in Medicaid at some point. Of those children, 51.5% were enrolled during all 5 years. Children with sociodemographic risk factors are more often enrolled for longer periods of childhood.

Pulmonary Embolism in the Pediatric Emergency

Department

Pulmonary embolism (PE) in the pediatric population is rare but does occur and is underrecognized. In adult emergency medicine, there are validated clinical decision rules derived to provide reliable and reproducible means of determining pre-test probability of PE.

There are known risk factors, signs, and symptoms that should raise the clinician’s suspicion of pulmonary embolism, even in the pediatric population.

Infant Abusive Head Trauma in a Military Cohort

Abusive head trauma (AHT) is a type of physical child abuse, with infants at the highest risk. Parental characteristics associated with AHT include stress, young age, and current military service. However, a comprehensive evaluation of AHT among military families is lacking.

Risk factors and rates of AHT among military families are similar to civilian populations when applying a similar deﬁnition. Infants born preterm or with birth defects may have a higher abuse risk.

In this randomized placebo-controlled prospective multicenter trial of hydroxyurea in very young children with sickle cell anemia, not selected for severity, hydroxyurea was associated with signiﬁcant medical cost savings due to a reduction in hospitalization expenses.

Childhood Interstitial Lung Diseases: An 18-year

Retrospective Analysis

Childhood interstitial lung diseases occur in a variety of clinical contexts and are associated with high morbidity and mortality. Advances in the understanding of disease pathogenesis and use of standardized terminology have facilitated increased case ascertainment.

This study demonstrates that cases of newly described forms of childhood interstitial lung diseases likely occur at all children’s hospitals. With advances in genetic testing and recognition of imaging patterns, a signiﬁcant portion of cases are identiﬁable with noninvasive evaluations.

Parental Preferences and Goals Regarding ADHD

Treatment

Shared decision-making involves the assessment of preferences and goals and has been prioritized in new attention-deﬁ cit/hy-peractivity disorder treatment guidelines, yet no studies have examined the impact of both preferences and goals on treatment initiation.

Supporting the clinical utility of preference and goal assess-ment, we found that parental treatment preferences are as-sociated with treatment initiation, and those with distinct goals select different treatments.

Disparities in Health Insurance Among Children

With Same-Sex Parents

Health insurance is associated with improved health for chil-dren, but gay and lesbian parents face barriers to adding their children to private health insurance. Little is known about the extent to which insurance disparities exist for children with same-sex parents.

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same-sex marriage, civil unions, domestic partnerships, or second-parent adoptions are available, disparities in private insurance diminish for children with same-sex parents.

Trends in Child Protection and Out-of-Home Care

Over the past decade, child welfare has focused on permanency for children through policy changes intended to reduce OOH placements. Yet little is known about recent trends in child maltreatment or children in OOH care.

Despite increased maltreatment investigations from 2000 through 2010, the population of children in OOH placements declined, while experiencing greater prior trauma and current emotional disturbance. These changes may have resulted in a smaller but more complex OOH population.

Oral Dexamethasone for Bronchiolitis: A

Randomized Trial

Some infants presenting with bronchiolitis are later diagnosed with asthma. Corticosteroid treatment of all infants with bronchiolitis is not clearly efﬁcacious.

We used infant eczema or asthma history in afirst-degree relative to select patients with bronchiolitis for dexamethasone or placebo blinded treatment. Dexamethasone treatment of 5 days led to significantly earlier readiness for discharge from infirmary treatment.

Trends in Invasive Methicillin-Resistant

Staphylococcus aureus

Infections

Invasive methicillin-resistant_{Staphylococcus aureus}(MRSA) in children is associated with high morbidity and mortality. Al-though reductions in health care–associated MRSA infection among adults are documented, it is unclear if a similar trend is occurring among children.

Data from population-based surveillance were analyzed to assess changes in invasive MRSA infection incidence over time. This analysis describes the epidemiology and trends of invasive MRSA infections among children in 9 US metropolitan areas and estimates national burden.

International Reach of Tobacco Marketing Among

Young Children

Prosmoking messages, delivered through marketing and the media, can reach very young children and inﬂuence attitudes and behaviors around smoking.

Marketing of tobacco and cigarette brands has successfully reached young children in low- and middle-income countries. More effective measures are needed to restrict the reach of tobacco marketing.

Vitamin D

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Supplementation and Childhood

Diarrhea: A Randomized Controlled Trial

Hypovitaminosis D is common among children. Although there is proliﬁc biochemical literature linking vitamin D to enteric immu-nologic function, there is a paucity of prospective data exploring the role of supplementation in prevention of diarrheal illnesses.

In a high-risk population, quarterly supplementation with 100 000 IU of vitamin D3did not reduce the risk forﬁrst or re-current diarrheal illnesses in a population of children aged 1 to 29 months in a low-income inner city setting.

Validity of Different Pediatric Early Warning Scores

in the Emergency Department

Pediatric early warning scores (PEWS) for hospital inpatients have been developed to identify patients at risk for de-terioration. Beyond triage, similar systems that identify ill patients and predict requirements for a higher level of care are needed in the emergency department.

The validity of the different PEWS in pediatric emergency care patients has never been evaluated. This study showed that PEWS are capable of detecting children in need of ICU admission.

Association of Race and Ethnicity With Management

of Abdominal Pain in the Emergency Department

Racial/ethnic differences in care for adult and pediatric patients in the emergency department have been documented.

This study reveals racial/ethnic differences in analgesic ad-ministration and prolonged length of stay for pediatric emergency department visits for abdominal pain. Documenting such disparities is an importantﬁrst step needed to improve the equity of care for this and other conditions.

ED Utilization Trends in Sports-Related Traumatic

Brain Injury

Traumatic brain injury (TBI) in children causes signiﬁcant morbidity and mortality. Parental and coach awareness about brain injury due to sports has recently increased. Since 2001, pediatric emergency departments have seen a signiﬁcant in-crease in sports-related TBI.

Pediatric, sports-related TBIs cared for in the emergency de-partment and admitted to the hospital have both increased, resulting in no change in the percentage being admitted. However, patients admitted have had a signiﬁcant reduction in injury severity.

Breastfeeding Concerns at 3 and 7 Days

Postpartum and Feeding Status at 2 Months

Although most US mothers initiate breastfeeding, half fail to achieve their breastfeeding intentions. In cross-sectional and

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Prediction of Neonatal Outcomes in Extremely

Preterm Neonates

Extremely preterm infants are at high risk of neonatal mortality or morbidities. Existing prediction models focus on mortality, speciﬁc morbidities, or composite mortality and morbidity outcomes and ignore differences in outcome severity.

A simple and practical statistical model was developed that can be applied on theﬁrst day after NICU admission to predict outcome severity spanning from no morbidity to mortality. The model is highly discriminative (_C-statistic = 90%) and internally valid.

Prevention of Traumatic Stress in Mothers With

Preterm Infants: A Randomized Controlled Trial

Parents of premature infants are susceptible to developing trauma symptoms related to their NICU experience. There are no current well-established interventions that simultaneously address both parental trauma as well as redeﬁnition of the parenting experience.

A brief, cost-effective, and feasible manualized intervention for NICU parents was effective in reducing both parental trauma and depression. Implementation of this intervention in the NICU setting has the potential to improve maternal well-being and infant outcomes.

Randomized Trial of a Population-Based,

Home-Delivered Intervention for Preschool Language Delay

Preschool language delay is associated with poorer academic performance, more limited employment opportunities, and re-lationship difﬁculties. Despite its importance within public health, there has been little progress toward effective population-based prevention and intervention approaches to improve outcomes.

It is feasible to identify low language in 4-year-olds on a population basis and deliver a 1-on-1 intervention. By age 5 years, this resulted in better phonological awareness and letter knowledge. There was weak evidence of better expressive, but not receptive, language.

Cerebral Palsy and Growth Failure at 6 to 7 Years

Surviving infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia have decreased rates of CP in

Developmental Trajectories of Daily Activities in

Children and Adolescents With Cerebral Palsy

Rehabilitation of people with cerebral palsy aims to achieve and maintain optimal performance in mobility and daily activities. Although insight into the developmental trajectories of activi-ties from childhood into adulthood is important, little is known about long-term development.

The gross motor function of children with cerebral palsy determines the developmental trajectories of mobility perfor-mance but not of daily activities, where intellectual disability was shown to be the determining factor.

The Rising Incidence of Celiac Disease in Scotland

The overall incidence of pediatric celiac disease (CD) is rising, as are other autoimmune conditions. Additionally, increasing numbers of children are older at the point of diagnosis and are diagnosed with CD through active screening.

Accounting for screened and nonclassic cases, there is an in-dependent 2.5-fold rise in the incidence of classically presenting cases of pediatric CD (Oslo deﬁnitions). Thus, indicating a true rise in pediatric CD incidence in southeast Scotland in 20 years.

Treatment Outcomes of Infants With Cyanotic

Congenital Heart Disease Treated With Synbiotics

Several studies have suggested that probiotics may prevent necrotizing enterocolitis and death in preterm infants. However, there are no data on the preventive effect of probiotics in infants with cyanotic congenital heart disease.

Although duration of hospitalization was not signiﬁcantly de-creased,_Biﬁ_{dobacterium lactis}plus inulin appears to decrease the rate of nosocomial infection, necrotizing enterocolitis, and death in infants with cyanotic congenital heart disease.

Clinical Characteristics of Pediatric Myasthenia: A

Surveillance Study

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This study describes the incidence, clinical features, diagnostic testing, and treatment trends of pediatric myasthenia in Canada, which have not been previously reported in the literature.

Evaluation of an Early Risk Screener for PTSD in

Preschool Children After Accidental Injury

Unintentional injuries lead to a signiﬁcant number of children suffering from long-lasting posttraumatic stress symptoms. Therefore, early identiﬁcation of individuals at risk is crucial to provide preventative interventions. However, currently, no early screener has been evaluated in preschool-aged children.

Good sensitivity (85%) and acceptable speciﬁcity (63%) were found for an early screening measure for preschool-aged children after accidental injury. Hence, the 21-item Pediatric Emotional Distress Scale–Early Screener, a reliable and valid early screening in-strument, is suggested for use within a stepped-care model.

Antepartum and Intrapartum Factors Preceding

Neonatal Hypoxic-Ischemic Encephalopathy

Etiology and timing of onset of neonatal hypoxic-ischemic en-cephalopathy continue to be controversial. Previous studies suggest antepartum events are the main contributing factors, but have used a broad deﬁnition of encephalopathy and in-cluded infants with genetic, congenital, and developmental abnormalities.

Our study suggests that when strict criteria deﬁning hypoxic-ischemic encephalopathy are applied with supporting neuro-imaging evidence of an acute hypoxic-ischemic insult, intrapartum events are theﬁnal and necessary pathway leading to this condition.

Change in Care Among Nonenrolled Patients During

and After a Randomized Trial

Participating in a trial may affect processes of care by par-ticipating physicians; however, no study has assessed whether it affects processes of care for nonenrolled patients.

Participation in a trial may affect processes of care for non-enrolled patients, even when care providers participating in or familiar with the trial protocol are unaware that data on nonenrolled patients are being collected for a study.

Validation of Self-Report Pain Scales in Children

The Faces Pain Scale–Revised and Color Analog Scale are self-report pain scales that are commonly used for children in the clinical and research settings.

The Faces Pain Scale–Revised and Color Analog Scale overall demonstrate strong psychometric properties in children 4 to 17 years of age, including within subgroups of age, sex, and ethnicity. Convergent validity, however, is questionable in children,7 years old.

See the table of contents of this issue to learn more about these articles.

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