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The article examines the relationship between age and obstructive sleep apnea (OSA) severity in infants under one year old who underwent polysomnography (PSG) due to sleep-related concerns. Topics discussed include age-related changes in OSA indices, the influence of comorbidities such as laryngomalacia, and variations in clinical outcomes among infants with different OSA severities.

Acute bronchiolitis is a leading cause of hospitalization in infants. In this retrospective study, 645 patients with acute bronchiolitis diagnosed as respiratory syncytial virus (RSV; n = 538) or human metapneumovirus (HMPV; n = 107) were compared in terms of demographic, clinical, and laboratory findings. The HMPV patients presented later in the winter, were older (20 vs 7.55 months; P <.001)), had higher levels of C-reactive protein (4.55 vs 3.03 mg/dL; P =.007), and a higher prevalence of complications (43.9% vs 32.7%; P =.03). This study highlights the similarities and differences between these 2 common respiratory viral pathogens and shows that HMPV has a slightly more severe disease course than RSV. These findings can help guide approaches to these 2 common viruses that cause bronchiolitis. [ABSTRACT FROM AUTHOR]

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P <.001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P <.001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P <.001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years. [ABSTRACT FROM AUTHOR]

The article discusses a study of the presentation of type 2 diabetes (T2D) in youth in the U.S. during the COVID-19 pandemic. The number of persons diagnosed with T2D increased to 34 in 2020 from 28 in 2019. It mentions the higher mean serum glucose in the 2020 cohort compared with the 2016 to 2019 cohort. It emphasizes the necessity for multisite collaborations to research impediments to optimal treatment of youth with T2D.

In this retrospective study of 319 children with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we assessed whether age, asthma, obesity, diabetes, and socioeconomic status were associated with hospitalization for coronavirus disease 2019 (COVID-19). Demographic and clinical characteristics were assessed using univariate statistics, excluding incidental or unrelated positives. There was a bimodal distribution of age among hospitalized children. Obesity (P <.001) and a past medical history of diabetes (P =.001) were significantly more prevalent in hospitalized children, including cases of new-onset diabetes and diabetic ketoacidosis. Neither a past medical history of asthma nor lower socioeconomic status was associated with hospitalization. Although limited to a single center, the findings in this study may have important clinical implications. Targeted, proactive health outreach to children with obesity and diabetes, with prioritization of preventative efforts such as vaccination, may be important in preventing worse SARS-CoV-2 infection in this vulnerable group. [ABSTRACT FROM AUTHOR]

The article informs about barriers to infant preventive care during the covid-19 pandemic, which disrupted all aspects of life for Americans, including their access to health care. Topics include hospitals and medical clinics were declared essential by government entities and professional organizations; and risk of vaccine-preventable infections, missed identification of delayed development, and decreased ability to foster family child mental health.

Personal health records (PHRs) have the potential to improve incomplete health records. However, internet access through traditional methods may be limited for populations most at risk for fragmented care. A convenience sample of postpartum women at a community hospital and tertiary-care academic center in New York City completed a self-administered survey. Most (75.2%, n = 200) women approached participated. The majority (70.0%) were Latina, 53.5% were Spanish speakers, 23.4% were uninsured, and 41.6% were publicly insured. Smartphone ownership (85.6%) including a data plan (80.0%) was high. While insurance and educational level were associated with decreased odds of internet access at home, access via cellphone only differed by age. Nearly all (94%) women wanted PHR access and interest only differed by language. Even the minority (20.0%) of women with concerns, reported high (93.8%) interest. High smartphone ownership, use of phone for internet access, and interest in PHR access, suggest the potential of optimizing PHR use via mobile technologies. [ABSTRACT FROM AUTHOR]

Term infants with hypertrophic pyloric stenosis (HPS) typically present between 4 and 6 weeks. There is limited consensus, however, regarding age of presentation of premature infants. We aim to determine if there is an association between the degree of prematurity and chronological age of presentation of HPS. A total of 2988 infants who had undergone a pyloromyotomy for HPS were identified from the 2012 and 2013 NSQIP-P Participant Use Files. Two hundred seventeen infants (7.3%) were born prematurely. A greater degree of prematurity was associated with an older chronological age of presentation (P < .0001). Prematurity was significantly associated with an increase in overall postoperative morbidity, reintubation, readmission, and postoperative length of stay. When clinicians evaluate an infant with nonbilious emesis with a history of prematurity, they should consider pyloric stenosis if the calculated postconceptional age is between 44 and 50 weeks. When counseling families of premature infants, surgeons should discuss the increased incidence of postpyloromyotomy morbidity. [ABSTRACT FROM AUTHOR]

Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth. [ABSTRACT FROM AUTHOR]

We compared demographic and clinical characteristics of pneumonia with and without pleural fluid (PF and Pn, respectively) in hospitalized children younger than 5 years in southern Israel, between 2002 and 2011. Overall, 108 PF and 5811 Pn episodes were recorded. Children with PF were older. Prematurity (6.6% vs 14.0%) and asthma (9.9% vs 23.5%) were less common in PF. Mean temperature and saturation were higher in PF while hemoglobin and sodium levels were lower in PF compared with Pn. Nasal washes were obtained in 30.6% and 39.9% of PF and Pn episodes, respectively, with respiratory syncytial virus identified more commonly in Pn (24.2% vs 42.3%). Streptococcus pneumoniae was identified in 5.2% and 0.9% of blood cultures in PF and Pn, respectively. In conclusion, PF differed from Pn in demographic and clinical characteristics, possibly due to differences in etiology. Although both diseases are considered bacterial, a high proportion of viral etiology was found in both, especially in Pn. [ABSTRACT FROM AUTHOR]

The 2013 US Preventive Services Task Force report found insufficient evidence for pediatric blood pressure screening. This retrospective study evaluated the reliability of successive annual blood pressure screening of children for hypertension at the 3-, 4-, and 5-year-old health maintenance visits (January 1, 2010 to June 18, 2014). Of 328 patients, 290 (88%) were normotensive at all 3 visits. All elevated blood pressures (≥95th percentile) were stage 1. No patient was hypertensive (3 elevated measures). The extended concordance correlation coefficient indicated poor agreement for systolic (0.19, 95% CI −0.49 to 0.72) and diastolic (0.11, 95% CI −0.39 to 0.56) measurements. Blood pressure at the 3-year (κ −0.008, 95% CI −0.11 to 0.09), 4-year (κ 0.09, 95% CI −0.06 to 0.24), or 5-year (κ 0.08, 95% CI −0.05 to 0.20) visit was not associated with elevated blood pressures at the other 2 time points. In the preschool years, stage 1 elevated blood pressures do not correlate with hypertension and may be better managed by watchful waiting and parental reassurance. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the impact of a client-centered behavioral intervention (Brief Negotiated Interviewing) on mothers’ human papillomavirus (HPV) vaccine knowledge and vaccination initiation for their adolescent daughters. Methods. We randomized mothers to intervention (n = 100) and control (n = 100) groups, and followed them over 12 months. Electronic medical records were reviewed to determine vaccination status. The primary outcome was receipt of the first vaccine. The secondary outcome was HPV vaccine knowledge among mothers. Results. Brief Negotiated Interviewing intervention mothers demonstrated increased knowledge about HPV (pre/post mean score of 5 to 10 out of a possible 11; P < .001) and significantly higher mean knowledge scores (10 vs 6, P < .001) than control mothers. However, initiation and completion rates of the vaccine were not significantly different between groups. Conclusions. Increasing HPV vaccine knowledge did not translate into increased vaccine uptake or completion of vaccination series. Future intervention must explore vaccine reminders to increase HPV vaccination rates. [ABSTRACT FROM AUTHOR]

Objective: To discuss the value of general movements assessment in predicting the neurological disorders. Methods: Using PubMed as the search engine, we searched to identify relevant studies in English and Chinese language published up to November 2014 and 19 studies were selected. Standard methods in meta-analyses were used to provide diagnostic accuracy by Meta-DiSc 1.4. Results: For non–cerebral palsy (non-CP) as outcome for writhing period, the results suggested a good sensitivity and a specificity of 0.74, the Q-value was 0.80. The area under the curve (AUC) was 0.87. For non-CP as outcome for fidgety period, the results suggested both high level for sensitivity and specificity. And the Q-value was 0.914, the AUC was 0.9664. For CP as outcome for writhing and fidgety periods, good sensitivity and specificity were found in the analysis, and the Q-value was 0.9034 while the AUC was 0.9592. Conclusion: General movements assessment is a good predictor for diagnosing neurological disorders. [ABSTRACT FROM AUTHOR]

Objectives. Primary immunodeficiency diseases (PIDDs) are caused by inherent deficits in immune defenses that result in abnormal susceptibility to infection. In most cases, early and appropriate diagnosis can improve patient outcomes. The objective of this study was to evaluate understanding, recognition, and diagnosis of PIDD among pediatricians. Methods. A mail survey sent to a sample of pediatricians obtained from the American Medical Association and American Osteopathic Association. Results were compared with a similar survey of specialists who are members of the American Academy of Asthma, Allergy and Immunology. Results. More than a third (35%) of pediatricians were uncomfortable with the recognition and diagnosis of PIDD despite 95% having ordered screening tests or referring patients to specialists to be evaluated for PIDD, and 77% having followed at leastone patient with PIDD. In all, 84% of pediatricians were unaware that professional guidelines for PIDD exist. Conclusions. Patients with PIDD would benefit from improved recognition of the diseases by pediatricians in order to facilitate earlier diagnosis and optimize ongoing therapy. [ABSTRACT FROM AUTHOR]

The article discusses a study investigating implications for engaging minority parents in weight-related discussions. It used identical survey components comparing Latino and African American samples. It reveals higher risk of misperceiving obese child's weight among low-income Latino parents as compared to low-income African American parents.

Objective. To examine food and beverage depictions in books for preschoolers. Methods. Books for preschoolers from Reach Out and Read (ROR; n = 42), public library (n = 27), and Publisher's Weekly booklists (n = 31) were examined for nutritive and empty-calorie food and beverage depictions. Results. It was found that 66% of books depicted at least 1 food or beverage. More books depicted nutritive items than empty-calorie items (87.5% vs 54.7%, P < .001). There was a trend toward fewer empty-calorie depictions in ROR books than in other booklists. Yet nearly half of ROR books depicted at least 1 empty-calorie item. ROR books also accounted for 5 of 10 books with the most empty-calorie item depictions and 3 of 4 books with branding. With regard to messaging, approximately a third of books with the most empty-calorie depictions promoted unhealthy foods. Conclusions. When selecting books for ROR, it may be important to consider food and beverage depictions and messages. [ABSTRACT FROM AUTHOR]

Objective: Current guidelines for Kawasaki disease (KD) recommend intravenous immunoglobulin infusion and echocardiography. However, no previous studies have evaluated the relationship between the treating hospital’s concordance with guidelines and the prevention of coronary artery aneurysm in patients with KD. Study Design: KD patients between 2010 and 2013 were identified in a Japanese national inpatient database. Guideline concordance was defined as the proportions of patients who received echocardiography as well as treatment with both immunoglobulin and aspirin, which were divided into quartiles. Multivariable logistic regression analysis was conducted to examine the association between the guideline concordance and the occurrence of coronary artery aneurysm with adjustment for patient backgrounds. Results: In sum, 20 156 patients with KD were identified. The very high (>83.3%) concordance group had a lower rate of coronary artery aneurysm than the very low (<59.0%) concordance group (4.9% vs 9.9%; odds ratio, 0.45; 95% CI, 0.27 to 0.74; P = .002). Conclusion: All patients with KD should be treated according to the guidelines. [ABSTRACT FROM AUTHOR]

Background. Missed appointments complicate primary care services. Objective. To determine factors associated with missed pediatric appointments. Design/Methods. A convenience sample of 1537 patients who missed appointments were called and 386 (25%) families completed the 26-item survey. Those with high no-show rates were compared with the rest using χ2 and Fisher’s exact tests. Initial covariates with P < .2 were included in a multivariate logistic regression model. Results. Common reasons for missing appointments were the following: forgot (27%), transportation problems (21%), and time off of work (14%). The high no-show group had more African Americans (P = .030) and older patients (P = .003). Higher no-show rates correlated with well child visits (P = .029) and perception of “excellent health” (P = .022). In the logistic regression model, well child appointments (odds ratio = 2.56) and increasing age in years (odds ratio = 1.11) were associated with higher no-show rates. Conclusions. Efforts to decrease no-show rates should target older patients and well child visits. [ABSTRACT FROM AUTHOR]

Objective. Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder. Methods. Survey of parents from 3 practices in Rochester, NY. Stepwise logistic regression analysis explored factors predicting respondents’ intentions for future use of PHR, accounting for care coordination needs, caregiver education, socioeconomic status, and satisfaction with providers. Results. Of 184 respondents, 23% had used the PHR for their child, 82% intended future use. No difference was observed between users and nonusers regarding gender, age, race, or education. Users were more likely than nonusers to reside in the suburbs (P = .03). Caregivers were more likely to plan future use of the PHR if they felt engaged as partners in their child’s care (adjusted odds ratio = 2.3, 95% confidence interval = 1.2, 4.5). Conclusions. Parents are enthusiastic about PHRs. Future work should focus on engaging them as members of the health care team. [ABSTRACT FROM PUBLISHER]

The evaluation for children with bruising may be affected by the specialty to which they are referred. We conducted a 3-year retrospective review of subjects referred for bruising to Child Abuse Pediatrics (CAP) or Pediatric Hematology to identify characteristics associated with referral to each specialty and to compare the diagnostic evaluations and diagnoses based on specialty. Of 369 subjects, 275 were referred to CAP and 94 to Hematology. Clinical exam findings were similar in both groups. Hematology referrals were significantly more likely to have laboratory evaluations. Among those referred to CAP, 9.5% had head computed tomography scans and 27.3% had skeletal surveys. No children referred to Hematology had these imaging studies performed. Hematology never diagnosed child physical abuse, and CAP never diagnosed bleeding disorders. Pediatric hematologists and CAPs perform different evaluations and reach different diagnostic conclusions for similar patients with bruising. Further investigation of these practice patterns is warranted. [ABSTRACT FROM AUTHOR]

Sexual harassment can be physical interaction and touching, as well as, psychological, environmental, or via Internet and text messaging. An online survey in an urban clinic asked children, aged 12 to 18 years the following: demographic data, height and weight, chronic medical conditions, healthcare use, questions concerning sexual harassment—witnessed and exposure, and finally questions from the Pediatric Symptom Checklist (PSC-35). Overall, 124 of 210 (59%) of the 12- to 18-year-olds surveyed had experienced sexual harassment, with the predominance being female 69% (80/116) versus 48% (49/92) male. Participants who had experienced sexual harassment were significantly more likely to score positive for psychological impairment than those who had not experienced sexual harassment (chi-square test P < .001; odds ratio: 4.7 (95% confidence interval, 1.9-11.8). There was a borderline significant association between elevated body mass index and having experienced sexual harassment (2-sample t test P = .08). Sexual harassment has a direct correlation to psychological impairment in adolescents, especially females. [ABSTRACT FROM PUBLISHER]

Objectives. This randomized controlled trial evaluated the effectiveness, feasibility, and acceptability of parent participation (PP) in an evidence-based method to reduce the pain of prekindergarten immunizations. Methods. Healthy children aged 4 to 6 years were randomized to a multimodal distraction method during administration of routine vaccines with PP and 1 medical assistant (experimental group) or 2 medical assistants (standard-of-care comparison group). Children and parents rated the pain after injections, and a blinded observer coded children’s pain from videotapes. Results. In all, 76 children participated. Despite group randomization, more children in the medical assistant–only group received a 3-injection series (25; 68%) than in the PP group (6 [15%], P = .001). After adjustment for this imbalance, child-reported pain was higher in the PP group compared with the medical assistant–only group (2.95 vs 1.75; F = 5.87; df = 1.66; d = 0.64; P < .02). There were no differences between groups for parent-reported and observer-rated measures of pain or in intervention fidelity, duration of procedure, or child or parent satisfaction. Conclusions. Although child-reported pain was higher for the PP group, the magnitude of the difference may not be clinically significant. PP was feasible and acceptable to both parents and children, did not take any longer, and reduced the need for additional medical personnel. Together, these data provide preliminary support for PP for prekindergarten immunization pain management. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the association between Interferon Gamma Release Assays (IGRAs) and Tuberculin Skin Test (TST) among children referred by pediatricians and clinics who did not participate in health department contact investigations. Topics discussed include an evaluation if IGRA results in children being seen for suspected latent tuberculosis infection (LTBI) and the option of a tiered approach for immunocompetent children with positive TSTs and an IGRA.

Background. Current data are limited on compliance with guidelines for the treatment of attention deficit/hyperactivity disorder (ADHD). Methods. A survey assessing compliance with ADHD guidelines for diagnosis and management was distributed to pediatricians in a practice research network. Comparisons were made by practitioner characteristics. Results. In all, 42/76 surveys were returned (55%). Respondents largely adhered to American Academy of Pediatrics (AAP) guidelines. A lower percentage reported compliance for rescreening with a standardized tool (80%), use of electrocardiograms (78% rarely use), and the use of routine additional testing (80% rarely use). Academic practitioners were more likely to rescreen (100% vs 79%, P < .05). Private practitioners more often used newer therapeutic agents (7% vs 44%, P < .01). Older graduates were more comfortable diagnosing at a young age (93% vs 56%, P < .01) and were more comfortable using sleep agents (60% vs 15%, P < .01). Conclusion. Pediatricians largely adhered to AAP guidelines. These findings support changes made to the guidelines in 2011. Differences in practice patterns exist by practitioner experience, location, and practice type. [ABSTRACT FROM PUBLISHER]

Background. To evaluate if a severity score could differentiate the severity of children with nontyphoid salmonellosis; clinical outcomes of antimicrobial therapy in nontyphoid salmonellosis children with different severities. Methods. Admitted children with nontyphoid salmonellosis from 1996 to 2009 were monitored. Enrolled patients were divided into no antibiotics, concordant, and discordant therapies. Besides, the patients were classified into mild, moderate, and severe group according to the severity score. Clinical outcomes were compared among them. Results. A total of 558 patients were enrolled. In no therapy subset, compared with mild group, patients had worse clinical outcomes and more complications in severe group. Patients receiving no therapy had better clinical outcomes in mild group. However, patients receiving concordant therapy (ceftriaxone) had better clinical outcomes in severe group. Conclusions. The severity score and local antibiotic susceptibility could serve as guides for antibiotic prescription for severe nontyphoid salmonellosis in children. Inappropriate antibiotic use would worsen clinical outcomes in children with mild nontyphoid salmonellosis. [ABSTRACT FROM PUBLISHER]

Objective. To describe parents’ experience with their child’s allergic rhinitis (AR) to inform management by the primary care provider (PCP). Study Design. Two hundred parents with a child 7 to 15 years old with AR symptoms within the past 12 months completed a paper survey. Results. The child’s AR was identified as a significant problem in spring (89.3%), fall (63.4%), summer (50.3%), and winter (21.4%); 51.3% had persistent disease. AR symptoms most commonly interfered with the child’s outdoor activities and sleeping, and frequently bothered the parent and other family members. Most parents (88.3%) wanted to know what their child was allergic to and had many concerns about treatment options. A total of 62.9% had sought AR care from the PCP in the past 12 months. Conclusions. Many families experience significant morbidity from their child’s AR and turn to their PCP for help. We identified opportunities for the PCP to reduce AR morbidity. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the use of rapid plasma reagin (RPR) test in screening for syphilis in adolescents using the electronic medical records of patients at aacademic medical center in New York City. Topics covered include the vaccination of patients with true-positive (TP) and false-positive (FP) RPR tests, the number of patients with rheumatologic disorders, and laboratory bills for each RPR test, RPR titers and fluorescent treponemal antibody absorption (FTA-ABS).

Objectives. To assess primary care pediatric providers’ comfort with co-managing patients with rare conditions. Methods. A survey was sent via an electronic link to pediatricians and family practitioners. Chi-square test of significance and Fisher’s exact test were used for categorical variable comparisons and the Student’s t test was used for continuous variable comparisons. Results. Most of the providers believed that care decisions are most frequently made by the specialist with consultation with the primary care clinician. The most common source of information is direct communication from the specialist. The most effective tool to increase clarity and comfort about provider roles was an active care plan identifying current care needs, who will act on the plan, and when the action should be completed. Conclusions. Coordinated co-management in which caregiving roles are explicitly defined and tools are available for the timely exchange of information among all key participants warrants further study. [ABSTRACT FROM PUBLISHER]

Objective. This study discusses the impact of mental health screening in pediatric primary care on the management of mental health concerns. Methods. Youth aged 11 years and their parents completed the Pediatric Symptom Checklist and chart reviews were used to gather information about discussion of mental health concerns and connection with mental health services. The study design was a post-intervention study with a concurrent comparison group of youth aged 12 years who were not offered a screening. The χ2 or Fisher’s exact tests and logistic regression were used to compare groups on outcome variables. Results. Parents who completed a mental health screening for their child were more likely to be referred and attend mental health services, attend a psychiatrist appointment, and discuss their concerns with the primary care provider compared with the comparison group. Conclusions. Screening by parents improves detection of problems and fosters conversations with providers and subsequent connection with services. [ABSTRACT FROM PUBLISHER]

The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler–spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient’s asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed. [ABSTRACT FROM PUBLISHER]

Background. Rates of body mass index (BMI) calculation and plotting remain low. We examined whether providing a BMI wheel and brief education to pediatric residents and attendings would increase rates of “BMI recognition” and obesity-related counseling. Methods. A delayed-control design was used to evaluate a 20-minute intervention. A total of 1640 records of well-child visits were reviewed to determine the proportion of records in which BMI was calculated and plotted and counseling provided. Results. In clinic A, there was a significant increase in the proportion of records in which BMI was recognized from pre- to postintervention (P < .01). No changes in clinic B occurred until after the delayed intervention. Obesity-related counseling was more likely to occur if BMI was recognized. Conclusion. Brief education and BMI wheel increased rates of BMI recognition. BMI recognition was associated with increased obesity management. Additional efforts should be incorporated to further increase BMI recognition and assist providers in treating these children. [ABSTRACT FROM AUTHOR]

Objective. To identify the percentage of parents who define the threshold for fever between 38.0°C and 38.3°C, which has not been reported previously, and to describe parental attitudes toward fever and antipyretic use. Study Design. Thirteen-question survey study of caregivers. Results. Overall, 81% of participants defined the threshold for fever as <38.0°C, 0% correctly defined fever between 38.0°C and 38.3°C, and 19% defined fever as >38.3°C. Twenty percent of children brought to clinic for a chief complaint of fever were never truly febrile. Ninety-three percent of participants believed that high fever can cause brain damage. For a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit. Conclusion. Our finding that 0% of parents correctly defined fever is both surprising and unsettling, and it should inform future discussions of fever between parents and clinicians. [ABSTRACT FROM PUBLISHER]

The article discusses a questionnaire-based survey which was conducted to assess familiarity of pediatricians with migraine in childhood, understand referral patterns, and study the use of medications in the management of childhood migraine. The results of the survey revealed that pediatricians are aware of diagnostic criteria for migraine and suggest appropriate treatment for acute episodes. They provide counseling regarding analgesic overuse but are hesitant to use prophylactic regimens.

Accumulating evidence suggests that the use of acetaminophen increases the risk of developing asthma and that its widespread use has contributed to the increasing prevalence of asthma. Study design. To investigate the immediate effect of a single dose of acetaminophen on airways reactivity and inflammation in asthmatic and controls. A double blind placebo-controlled study was conducted on 42 asthmatic children and 21 healthy age-matched controls. Each participant received one oral dose of acetaminophen (15 mg/kg [160 mg/mL]) and one dose of a volume-matched placebo. Physical examination, spirometry results, and fractional exhaled nitric oxide levels were assessed before and 60 minutes following acetaminophen or placebo ingestion. Results. None of the studied variables showed any significant change after acetaminophen or placebo ingestion in either the asthmatic or the control groups. Conclusions. One single dose of acetaminophen neither evokes a bronchoconstriction response nor an increase in airway inflammation in children with asthma. [ABSTRACT FROM AUTHOR]

Purpose. Investigations were conducted on whether screening for adolescent depression was feasible and acceptable to patients in low-income, urban, predominantly Latino clinics. Further investigations were undertaken for provider acceptance of such screening. Methods. Adolescents aged between 13 and 20 years presenting to 3 pediatric and adolescent primary care practices affiliated with an academic medical center in New York City were screened for depressive symptoms using the Columbia Depression Scale. Providers were surveyed pre- and postimplementation of the screening regarding their attitudes and practices. Results. The vast majority (92%) of those approached accepted the screening. Twelve percent of those screened were referred for mental health treatment. Providers reported satisfaction with the screening tool and a desire to continue to use it. Screening was limited to 24% of eligible participants, and only 10% of screens were at sick visits. Conclusions. The Columbia Depression Scale seems acceptable to adolescent providers and patients in the mostly Latino study population. It may prove to be a helpful tool in evaluating adolescents presenting to primary care for depression. Further study will be required in other Spanish-speaking and minority populations. New methods will also be required to reach a greater proportion of patients, particularly those presenting for sick visits. [ABSTRACT FROM AUTHOR]

The article discusses a study assessing incidental findings in children with head trauma undergoing computed tomography (CT) scan in the emergency department (ED) is discussed. It shows that 26% had a clinically relevant incidental finding with sinus opacification being the most common. It recommends that clinicians should consider forming protocols to manage these findings and should consider the potential of discovering an incidental finding that may modify clinical management.

Patient-centered care requires pediatricians to address parents’ health concerns, but their willingness to solicit parental concerns may be limited by uncertainty about which topics will be raised. The authors conducted surveys of parents to identify current health-related issues of concern. [ABSTRACT FROM PUBLISHER]

The article discusses the results of a study that determines how low-income parents of 2- to 5-year-old children rank known risk factors related to early-childhood obesity. The study showed that 7.4 percent of parents considered low levels of physical activity a top risk factor while inability to control the food choices of alternate caregivers was the major barrier to achieving a healthy child weight. It concludes that low-income parents are aware of high-risk feeding behaviors.

Objective. There are few established diagnostic tools to define non-IgE-mediated food hypersensitivity reactions. Cow milk protein allergy (CMPA) is a multisystem disorder affecting the gastrointestinal, skin, and lower and upper airway systems. This link is frequently missed because of subspecialty evaluation of the multisystem effects individually. The authors hypothesize that a more global evaluation based on a simple scored questionnaire will reveal this link. Methods. Over an 18-month period, children younger than 2 years with non-IgE-mediated CMPA were identified. A symptom questionnaire was developed and scored and also applied to a control population. The prevalence of symptoms in each group was compared and a cumulative score was determined. Symptoms evaluated included gastrointestinal, aerodigestive, lower airway, and skin symptoms. A positive response was scored 1 and a negative response scored 0. Results. Significant differences in prevalence rates between CMPA and control populations were noted, particularly in aerodigestive symptoms. There were marked differences in cumulative score between populations (P < .001). The authors identified a cut-off score at which there was close to 80% sensitivity and 90% specificity for distinguishing CMPA from a control population. Conclusion. A global evaluation of multiple systems can be an important diagnostic tool in determining CMPA in infants. [ABSTRACT FROM PUBLISHER]

In children, most colonic polyps are juvenile polyps with negligible risk for malignant transformation. The exception is juvenile polyposis syndrome (JPS) where there is a risk for developing colon cancer. The authors studied differences in clinical features and colonoscopic findings in children with solitary juvenile polyps (SJP), multiple juvenile polyps (MJP), and JPS. Methods. Children were identified as SJP (1 polyp), MJP (2-4 polyps), or JPS (>5 polyps). Demographic data, laboratory values, family history, and colonoscopic findings were recorded. Results. Children having polypectomy had juvenile polyps (93%), adenomatous polyps (5%), and Peutz–Jegher syndrome (3%). Juvenile polyps were classified as SJP (67%), MJP (16%), and JPS (17%). Children with SJP were younger, were more likely to have polyps limited to the rectosigmoid colon, and had larger polyps than children with MJP and JPS. Anemia was more common in JPS than MJP and SJP. Conclusion. Clinical and endoscopic findings differ between SJP, MJP, and JPS. [ABSTRACT FROM PUBLISHER]

The aim was to systematically review genetic testing guidelines in the evaluation of children with autism spectrum disorders (ASDs). The Clinical Report published by the American Academy of Pediatrics (AAP)1 recommended individualizing the workup, including karyotype and specific DNA testing for fragile X syndrome. A recent publication reported higher rates of abnormalities on CGH microarray (CMA) testing on children with ASD.2 The medical records of 507 children seen through the Kirch Developmental Services Center were abstracted for genetic testing and factors associated with this testing. Abnormalities were found on karyotype in 2.3% and in DNA for fragile X in 0.04%. The author concludes that the diagnostic yield of the genetic testing was low in this population. Furthermore, their findings support the theory that CMA can be considered as part of the initial genetic screening in children with ASD in most situations. Future studies will need to be done prospectively to evaluate children in a standard fashion. [ABSTRACT FROM PUBLISHER]