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Both obesity and non-alcoholic fatty liver disease (NAFLD) increase the risk of metabolic abnormalities. However, the metabolic status of children suffering from NAFLD and exhibiting various subtypes of obesity is currently unclear. We aimed to explore the association between NAFLD and metabolic abnormalities in children with different weight statuses. We included 6086 participants aged 6–18 years from the China Child and Adolescent NAFLD Study (CCANS), all of whom had undergone ultrasonography or magnetic resonance imaging-proton density fat fraction (MRI-PDFF) to identify NAFLD and metabolic abnormalities, including hyperglycemia, high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol, high total cholesterol, and hyperuricemia. Among the participants, there were 2408 children with obesity and NAFLD, 174 with NAFLD, 2396 with obesity, and 1108 without obesity and NAFLD. The odds ratios (ORs) of suffering from individual metabolic abnormalities were significantly greater in children with obesity and NAFLD than in children without obesity and NAFLD, with ORs ranging from 6.23 (95% CI: 4.56, 8.53) to 1.77 (95% CI: 1.06, 2.94). The ORs of metabolic abnormalities, except for low HDL-C, were greater in children with NAFLD alone than in children without obesity or NAFLD, with ORs ranging from 4.36 (95% CI: 2.77, 6.84) to 2.08 (95% CI: 1.14, 3.78). Notably, obesity and NAFLD had a multiplicative effect on overall metabolic abnormalities, high TG levels, and low HDL-C levels. Children with obesity and NAFLD could be at a significantly increased risk of metabolic abnormalities. Even for children without obesity, NAFLD appears to be associated with an increased risk of experiencing a worsened metabolic status. [ABSTRACT FROM AUTHOR]

Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions. This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics. Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns. Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall. The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores. A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership. Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster. Children in this study displayed different dietary patterns, with key sociodemographic variation. [ABSTRACT FROM AUTHOR]

• Real and imagined challenges have limited pediatric lipid screening. • Implementation science provides opportunities to shrink screening gaps in care. • Creative and collaborative efforts empower partnerships to improve screening. Recent guidance by the United States Preventive Services Task Force has renewed the debate surrounding the benefits of pediatric lipid screening. This commentary reviews the evolution of the pediatric lipid screening recommendations in the United States, followed by an exploration of real and imagined challenges that prevent optimal cholesterol screening rates in children. Real challenges substantively prevent the uptake of these guidelines into practice; imagined challenges, such as identifying the best age to screen, are often context-dependent and can also be surmounted. Experiences from other countries identify potential facilitators to improving screening and additional barriers. Implementation science provides guidance on overcoming the real barriers, translating evidence-based recommendations into clinical practice, and informing the next wave of solutions to overcome these challenges. [ABSTRACT FROM AUTHOR]

Lyme disease (LD) is the most common vector-borne disease in the United States, with increasing incidence and geographic range. Case incidence peaks among school-aged children. New LD preventives are in clinical trials. We conducted an online survey of parents of children aged 5–18 years in states with high or emerging incidence of LD. Our primary outcome was willingness ("definitely" or "probably") for their child to receive an LD vaccine. Our secondary outcome was preference for annual monoclonal antibody injections compared to a 3-dose vaccine series with boosters. Analyses were weighted to reflect parent gender, parent race/ethnicity, and child age by state. Among 1,351 parent respondents, most (68.0 %) would have their child vaccinated against LD, with significantly more being willing in high compared to emerging incidence states (70.4 % versus 63.6 %, p = 0.027). Of parents who were unsure or unwilling, 33.5 % and 16.5 %, respectively, would do so with a provider recommendation. Vaccine safety concerns were among the top reasons for LD vaccine hesitancy. More parents preferred a pre-formed antibody (42.3 %) compared to a 3-dose vaccine series (34.7 %). Significant predictors of willingness to have one's child vaccinated were higher parental education; higher perceived risk of child getting LD; child spending time outdoors daily or weekly; following a regular vaccine schedule; and positive attitude towards vaccines. Significant predictors of preference for monoclonal antibody over a 3-dose vaccine series included prior awareness of LD, living in a rural area, and less positive attitudes towards vaccines. Two-thirds of parents in high and emerging incidence states would vaccinate their children against Lyme disease. Addressing safety concerns will be important, and a health care provider recommendation could also encourage those who are unsure or unwilling. Given the slight preference for monoclonal antibody over vaccine, particularly in rural areas, access to both may increase LD prevention. [ABSTRACT FROM AUTHOR]

• Youth ATV operators typically have a diminished field of vision compared to adults. • Limited vision in youth compromises control and perception, increasing crash risks. • Findings provide data to update ATV safety guidelines and prevention strategies. Problem: All-Terrain Vehicles (ATVs) cause a distressing number of fatalities and injuries among farm youth in the United States. The number of severe injuries caused by ATV crashes on farms, which stood at 25 children in 2019, is expected to rise due to increased ATV sales during the COVID-19 pandemic. Existing research into children's injuries has explored physical capabilities like anthropometry, strength, and visual acuity. Yet, studies assessing youths' physical ability to operate ATVs remain limited. This study tests the hypothesis that diminished vision field in young ATV operators raises crash risks. Methods: This study used SAMMIECAD digital human modeling system to simulate and compare the field of vision of youth and adult ATV operators. The simulations incorporated 3-D mockups of ATVs, humans, sprayer tanks, windshields, and obstacles. Ten utility ATVs and children of both genders across nine ages (8–16) and three height percentiles (5th, 50th, 95th) were evaluated. Results: Simulations showed that young ATV operators generally have a more restricted field of vision than adults, particularly those aged 6–11 years. Discussion: Visual limitations hinder riders' ability to see ATV controls, potentially leading to vehicle control loss. Moreover, they impair environmental perception during riding, compromising youths' ATV operation abilities and increasing crash risks. Practical Applications: These findings offer crucial data in support of modifying ATV safety guidelines. Additionally, they can guide youth occupational health professionals in preventing ATV-related incidents in agricultural settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Telehealth use in pediatrics increased during the COVID-19 pandemic and may improve health care access. It may also exacerbate health care disparities among families with limited English proficiency (LEP). OBJECTIVE: To systematically review the feasibility, acceptability, and/or associations between telehealth delivery and health outcomes for interventions delivered synchronously in the United States. DATA SOURCES: PubMed, Embase, and Scopus. STUDY ELIGIBILITY CRITERIA: Original research exploring pediatric health outcomes after telehealth delivery and studies that explored the feasibility and acceptability including surveys and qualitative studies. PARTICIPANTS: Patients 0 to 18 years with LEP and/or pediatric caregivers with LEP. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened abstracts, conducted full-text review, extracted information using a standardized form, and assessed study quality. A third author resolved disagreements. RESULTS: Of 1831 articles identified, 9 were included in the review. Half of the studies explored videoconferencing and the other half studied health care delivered by telephone. Feasibility studies explored telehealth for children with anxiety disorders and mobile phone support for substance abuse treatment among adolescents. Acceptability studies assessed parental medical advice-seeking behaviors and caregivers' general interest in telehealth. Health outcomes studied included follow-up of home parenteral nutrition, developmental screening, and cognitive behavioral therapy. LIMITATIONS: The articles were heterogeneous in approach and quality. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Telehealth appears acceptable and feasible among children in families with LEP, with a limited evidence base for specific health outcomes. We provide recommendations both for the implementation of pediatric telehealth and future research. [ABSTRACT FROM AUTHOR]

Examine children's mental health symptoms, including changes during the COVID-19 pandemic. The COVID Experiences Surveys, designed to be representative of the U.S. household population, were administered online to parents of children aged 5–12 years (wave 1 (W1), October–November 2020, n = 1561; wave 2 (W2), March–May 2021, n = 1287). We modeled changes in children's symptoms of anxiety, depression, and psychological stress and examined associations between demographic characteristics, COVID-19 related experiences, and protective factors with symptoms across both waves using generalized estimating equations. Based on parent-report, children's symptoms of anxiety and depression decreased from W1 to W2 (Δ t -score anxiety = −1.8 [95% confidence intervals (CI): −2.5, −1.0]; Δ t -score depression = −1.0 [CI: −1.7, −0.3]). Psychological stress remained consistent. Across waves, older children and children with an emotional, mental, developmental, behavioral, physical, or medical condition were more likely to have specific poor mental health symptoms. Poor mental health symptoms were more likely among children with several contextual stressors (e.g., economic stress, parental emotional strain) and less likely among children with protective factors (e.g., daily routines, neighborhood cohesion). Establishing programs that support mental health, improving access to mental health services, and fostering collaborations to advance children's mental health is important. [ABSTRACT FROM AUTHOR]

We investigated the association between chronic pediatric neurological conditions and the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This matched retrospective case-control study includes patients (n = 71,656) with chronic complex neurological disorders under 18 years of age, with laboratory-confirmed diagnosis of COVID-19 or a diagnostic code indicating infection or exposure to SARS-CoV-2, from 103 health systems in the United States. The primary outcome was the severity of coronavirus disease 2019 (COVID-19), which was classified as severe (invasive oxygen therapy or death), moderate (noninvasive oxygen therapy), or mild/asymptomatic (no oxygen therapy). A cumulative link mixed effects model was used for this study. In this study, a cumulative link mixed effects model (random intercepts for health systems and patients) showed that the following classes of chronic neurological disorders were associated with higher odds of severe COVID-19: muscular dystrophies and myopathies (OR = 3.22; 95% confidence interval [CI]: 2.73 to 3.84), chronic central nervous system disorders (OR = 2.82; 95% CI: 2.67 to 2.97), cerebral palsy (OR = 1.97; 95% CI: 1.85 to 2.10), congenital neurological disorders (OR = 1.86; 95% CI: 1.75 to 1.96), epilepsy (OR = 1.35; 95% CI: 1.26 to 1.44), and intellectual developmental disorders (OR = 1.09; 95% CI: 1.003 to 1.19). Movement disorders were associated with lower odds of severe COVID-19 (OR = 0.90; 95% CI: 0.81 to 0.99). Pediatric patients with chronic neurological disorders are at higher odds of severe COVID-19. Movement disorders were associated with lower odds of severe COVID-19. [ABSTRACT FROM AUTHOR]

Food insecurity is standardly measured at the household level or for groups of household members. However, food hardships may differ for individuals within households. Summary measures of people's individual experiences of food insecurity are needed. This study aims to develop and analyze psychometrically sound multi-item scales of people's individual experiences of food insecurity. It further aims to examine whether and how the distributions of personal food insecurity differ across age groups, from household food insecurity, and with people's observed characteristics. The study analyzes questionnaire data on personal food security outcomes, household food security outcomes, and other characteristics. The 29,040 participants in the study responded to the 2005-2006 through 2009-2010 cycles of the National Health and Nutrition Examination Survey in the United States. The main outcomes are five-item scales of personal food insecurity for children younger than age 12 years, young adolescents aged 12 to 15 years, and people aged 16 years and older. The study develops the personal food insecurity scales through factor analyses and polytomous Item Response Theory models and analyzes characteristics that are related to the scale outcomes through multivariate regressions. The article develops personal food insecurity scales that are related to but distinct from the standard household scales, with different scales being needed to capture the experiences of its three age groups. Children younger than age 12 years have much lower risks of personal food insecurity than other age groups, whereas young adolescents have higher risks than other groups. Three percent of children had an indication of personal food insecurity, whereas 10% of adolescents and 7% of adults had indications. Among adults, women and people between ages 31 and 65 years have higher risks of personal food insecurity than men and people of other ages, but they have similar risks for household food insecurity. Personal food insecurity is a distinct component of well-being that can be summarized through scale measures. Evidence that characteristics, such as sex and age, are related to personal food insecurity but not household food insecurity indicates that food experiences can differ within households and that some people may be systematically disadvantaged. [ABSTRACT FROM AUTHOR]

Physical punishment of children remains quite common and yet has only negative effects on children's health, making it an important public health problem. This study was designed to assess positive attitudes about and perceived normative support for the use of physical punishment with children, as well as attitudes regarding prohibition of physical punishment in homes and schools. This was a cross-sectional national survey of a diverse sample of US adults (N = 3049). This survey, conducted in Fall 2020, assessed attitudes and perceived norms regarding physical punishment use using continuous measures as well as support and perceived support for policies prohibiting physical punishment in homes and schools in the United States. Respondents who had positive attitudes toward physical punishment (39%) and who perceived normative support for physical punishment (41%) were not in the majority. While 65% agreed that there should be a federal ban on physical punishment in public schools, only 18% perceived that most US adults would support such a ban. Persons who were older (aged ≥55 years), men, living in the southern United States, or who themselves were hit more frequently as children were significantly less likely than their counterparts to support a federal ban in schools. Based on a national sample, there is strong support for a federal ban on physical punishment in US schools; yet this normative belief is unrecognized. Social norms campaigns should capitalize on this pluralistic ignorance to increase mobilization toward policy reform and reduction of harm to children through bans of physical punishment in public schools. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. METHODS: Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. RESULTS: In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. CONCLUSIONS: Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The estimated prevalence of learning disabilities (LDs) is nearly 8% of all children. Fewer than 5% of all children are diagnosed in public schools, jeopardizing remediation. We aimed to identify barriers affecting front-line childfacing professionals in detecting LDs in school-aged children. METHODS: We conducted a qualitative study with individual interviews of 40 professionals from different areas of the United States identified through theoretical sampling (20 educators, 10 pediatricians, and 10 child mental health clinicians). Clinicians represented academic and community settings, and educators represented public, private, and charter schools. Twenty had expertise in assessing LDs; 20 were generalists without specific training. We also endeavored to maximize representation across age, gender, race and ethnicity, and location. We analyzed transcripts utilizing grounded theory and identified themes reflecting barriers to detection. RESULTS: Themes and sub-themes included: 1) areas requiring improved professional education (misconceptions that may hinder detection, confounding factors that may mask LDs, and need for increasing engagement of parents or guardians in identifying LDs) and 2) systemic barriers (time constraints that limited professionals' ability to advocate for children and to delve into their emotional experiences, inconsistent guidelines across institutions and inconsistent perceptions of professional responsibility for detection, and confusion surrounding screening tools and lack of screening by some professionals in the absence of overt problems). CONCLUSIONS: Clinicians and other child-facing professionals may benefit from augmented training in screening and identification and enhanced evidence-based and institutional guidance. These efforts could increase efficiency and perceived responsibility for recognition and improve earlier detection. [ABSTRACT FROM AUTHOR]

• Pediatric product-related injuries are an important public health problem. • Recent epidemiology remains unexamined for pediatric product-related injuries. • Pediatric product-related injury morbidity declined consistently during 2001–2020. • Pediatric product-related injury morbidity spectrum varied across subgroups. • Efforts should be enhanced to address pediatric product-related injury in the United States. Introduction: This study examined changes in product-related injury morbidity among under-20 Americans between 2001 and 2020. Method: Product-related injury morbidity data came from the National Electronic Injury Surveillance System (NEISS). Using age-standardized morbidity rates, the authors performed Joinpoint regression models to identify time periods with significant changes between 2001 and 2020 and quantified the annual magnitude of morbidity changes with annual percent changes (APCs) in rates and 95 % confidence intervals (CIs). Results: Age-standardized product-related injury morbidity declined consistently among under-20 Americans from 2001 to 2020 (from 7449.3 to 4023.5 per 100,000 persons; APC = -1.5 %, 95 % CI: −2.3 %, −0.7 %), with the most striking morbidity drop in 2019–2020 (-1576.8 per 100,000 persons). Sports and recreation equipment and home were the most common product and location, respectively, for nonfatal pediatric product-related injuries. Large morbidity differences and varying spectrum by product and by occurring location existed across sex and age groups. Conclusions: Product-related injury morbidity declined significantly among under-20 Americans between 2001 and 2020, but large variations remained across sex and age groups. Practical Applications: Further research is recommended to understand causal factors contributing to the observed decrease in product-related injury morbidity over the past 20 years and to understand product-related injury morbidity disparities across sex and age groups. Understanding of causal factors could lead to implementation of additional interventions to reduce product-related injury among children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: To determine whether school infrastructure is associated with health and academic outcomes among elementary school children with asthma. Methods: We conducted a retrospective cohort study of linked medical, academic, and facilities data from a large mid-Atlantic school district of the United States. All K-5 students with asthma who were enrolled under the state's Children's Health Insurance Program were included. We estimated associations of the infrastructure quality of the student's school, as assessed by an engineering firm in Summer 2011 and represented by the Facility Condition Index (FCI), with asthma health outcomes, absenteeism, and standardized test scores in math and reading in the 2 academic years thereafter. Results: A total of 6558 students were identified, the majority non-Hispanic Black, across 130 schools. Most schools (97/130, 75%) were in very poor or worse condition. In cluster-adjusted models accounting for demographics, grade, school-specific area deprivation, and inhaled corticosteroid use, a one standard deviation increase in FCI, corresponding to greater infrastructure deficiency, was associated with higher rates of asthma-related hospitalizations (incidence rate ratio [IRR] 1.16; 95% confidence interval [CI] 1.03, 1.32), more absenteeism (IRR 1.05; 95% CI 1.01, 1.08), and lower scores in math (mean difference [MD] -3.3; 95% CI -5.5, -1.2) and reading (MD -3.0; 95% CI -5.1, -0.9). There were no differences in rates of asthma-related emergency visits or steroid prescriptions. Conclusions: Children with asthma attending schools with poorer infrastructure had worse health and academic outcomes. Public policy emphasizing reinvestment in school infrastructure may be a potential means of addressing asthma disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Ear, nose, throat, and respiratory infections (ENTRI) may affect children with complex chronic conditions (CCC) differently than their peers. We compared ENTRI prevalence and spending in children with and without CCCs. METHODS: Retrospective analysis of 3,880,456 children ages 0-to-18 years enrolled in 9 US state Medicaid programs in 2018 contained in the IBM Watson Marketscan Database. Type and number of CCCs were distinguished with Feudtner's system. ENTRI prevalence, defined as ≥1 healthcare encounters for ENTRI, and Medicaid spending on ENTRI were compared by CCC using chi-square tests and logistic regression. RESULTS: ENTRIs were greater in children with vs. without a CCC (57.7% vs 43.5% [P < .001]). Children with a CCC (5.5%, n = 213,425) accounted for nearly one-fourth ($145.8 million [US]) of total spending on ENTRI. Aside from throat and sinus infection, ENTRI prevalence increased with number of CCCs (P < .001). For example, as number of CCCs increased from zero to ≥3, lower-airway infection increased from 12.5% to 37.5%, P < .001 (OR 4.10; 95% CI 3.95-4.26). ENTRI spending attributable to inpatient care increased from 9.7% to 92.8% (P < .001) as the number of CCCs increased from zero to ≥3. CONCLUSION: Most children with a CCC pursued care for ENTRI in 2018 and these children accounted for a disproportionate share of ENTRI spending. Children with multiple CCCs had a high prevalence of lower-airway infection; most of their ENTRI spending was for inpatient care. Providers can use these findings to counsel patients and families and to inform future investigations on how best to manage ENTRI in children with CCCs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The United States has the highest incarceration rate in the world, with spillover impacts on 5 million children with an incarcerated parent. Children exposed to parental incarceration (PI) have suboptimal health care access, use, and outcomes in adulthood compared to their peers. However, little is known about their access and utilization during childhood. We evaluated relationships between PI and health care use and access throughout childhood and adolescence. METHODS: We analyzed the nationally representative 2019 National Health Interview Survey Child Sample to examine cross-sectional associations between exposure to incarceration of a residential caregiver, access to care, and health care use among children aged 2-17. Respondents were asked about measures of preventive care access, unmet needs due to cost, and acute care use over the last year. We estimated changes associated with PI exposure using multiple logistic regression models adjusted for age, sex, race, ethnicity, parental education, family structure, rurality, income, insurance status, and disability. RESULTS: Of 7,877 sample individuals representing a weighted population of 63,046,969 children, 484 (weighted 3,761,207; 6.0% [95% CI 5.4-6.6]) were exposed to PI. In adjusted analyses to produce national estimates, exposure to PI was associated with an additional 123,703 children lacking a usual source of care, 114,795 with forgone dental care needs, 75,434 with delayed mental health care needs, and 53,678 with forgone mental health care needs. CONCLUSIONS: Exposure to PI was associated with worse access to a usual source of care and unmet dental and mental health care needs. Our findings highlight the need for early intervention by demonstrating that these barriers emerge during childhood and adolescence. [ABSTRACT FROM AUTHOR]

Food allergies have become a global epidemic, affecting more than 10% of the population and 8% of children worldwide. Eliminating or limiting a food group from the diet can adversely impact micronutrient consumption. Milk allergies can impact the amount of calcium consumed in the diet, serving as a barrier to meeting daily calcium needs. Previous research evaluates the nutritional impact food allergies may have on children diagnosed with food allergies; however, there is a marked gap in literature that investigates the impact that children's allergy may have on their parent or caregiver. We hypothesized that milk elimination in a child's diet resulting from a milk allergy is associated with inadequate calcium intake among parents. Study participants (n = 55) lived in the United States and included parents or caregivers of a child with a diagnosed milk allergy (experimental group) and parents of a child without a milk allergy (control group). Calcium intake was estimated by using the validated Calcium Assessment Tool. Results demonstrated that the experimental group consumed significantly less calcium (273 mg/d) than the control group (520 mg/d; P <.01). Notably, both groups consumed inadequate calcium relative to the calcium Recommended Dietary Allowance for adults of 1000 mg/d, although calcium supplementation was not assessed in this study. Key findings from this study indicate widespread inadequate dietary calcium intake and suggest a need for increased calcium consumption in this population. [Display omitted] This research study compares estimated daily calcium intake between an experimental group (parents/caregivers of a child with a milk allergy) and a control group (parents/caregivers of a child without a milk allergy). Calcium intake was assessed using the Calcium Assessment Tool, a food frequency questionnaire (FFQ). Results demonstrated higher calcium intake among control group participants compared with the experimental group (520 mg vs. 273 mg, respectively). [ABSTRACT FROM AUTHOR]

Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear. This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years. Cross-sectional analysis of 2007-2018 National Health and Nutrition Examination Survey data using two, caregiver proxy, 24-hour dietary recalls. US children aged 2 to 5 years (n = 3,313) with at least one snack occasion over 2 days of intake. Snacking parameters included frequency (number of occasions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking. Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates. Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.00%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent. These nationally representative findings provide evidence that the consumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics. [ABSTRACT FROM AUTHOR]

Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Community health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting. OBJECTIVE: To determine outcomes and best practices of school-based community health worker interventions. DATA SOURCES: PubMed, CINAHL, and SCOPUS databases. STUDY ELIGIBILITY CRITERIA: This systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States. PARTICIPANTS: Community health workers, children, and/or their parents INTERVENTIONS: School-based community health worker programs RESULTS: Of 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention. LIMITATIONS: This review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9-21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies. [ABSTRACT FROM AUTHOR]

The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the association between cumulative aluminum exposure from vaccines before age 24 months and persistent asthma at age 24 to 59 months. METHODS: A retrospective cohort study was conducted in the Vaccine Safety Datalink (VSD). Vaccination histories were used to calculate cumulative vaccine-associated aluminum in milligrams (mg). The persistent asthma definition required one inpatient or 2 outpatient asthma encounters, and ≥2 long-term asthma control medication dispenses. Cox proportional hazard models were used to evaluate the association between aluminum exposure and asthma incidence, stratified by eczema presence/absence. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) per 1 mg increase in aluminum exposure were calculated, adjusted for birth month/year, sex, race/ethnicity, VSD site, prematurity, medical complexity, food allergy, severe bronchiolitis, and health care utilization. RESULTS: The cohort comprised 326,991 children, among whom 14,337 (4.4%) had eczema. For children with and without eczema, the mean (standard deviation [SD]) vaccine-associated aluminum exposure was 4.07 mg (SD 0.60) and 3.98 mg (SD 0.72), respectively. Among children with and without eczema, 6.0% and 2.1%, respectively, developed persistent asthma. Among children with eczema, vaccine-associated aluminum was positively associated with persistent asthma (aHR 1.26 per 1 mg increase in aluminum, 95% CI 1.07, 1.49); a positive association was also detected among children without eczema (aHR 1.19, 95% CI 1.14, 1.25). CONCLUSION: In a large observational study, a positive association was found between vaccine-related aluminum exposure and persistent asthma. While recognizing the small effect sizes identified and the potential for residual confounding, additional investigation of this hypothesis appears warranted. [ABSTRACT FROM AUTHOR]

To use a model-based approach to estimate vaccination coverage of routinely recommended childhood and adolescent vaccines for the United States. We used a hierarchical model with retrospective cohort data from eleven IIS jurisdictions, which contains vaccination records submitted by providers. Numerators included data from 2014 to 2019 at the county level for 2.4 million children at age 24 months and 14.4 million adolescents aged 13–17. Age-appropriate Census populations were used as denominators. Covariates associated with childhood and adolescent vaccinations were included in the model. Model-based estimates for each county were generated and aggregated to the national level to produce national vaccination coverage estimates and compared to National Immunization Survey (NIS) estimates of vaccination coverage. Trends of estimated vaccination coverage were compared between the model-based approach and NIS. From 2014 to 18, model-based national vaccination coverage estimates were within ten percentage points of NIS-Child vaccination coverage estimates for most vaccines among children at age 24 months. One notable difference was higher model-based vaccination coverage estimates for hepatitis B birth dose compared to NIS-Child coverage estimates. From 2014 to 19, model-based national vaccination coverage estimates were within ten percentage points of NIS-Teen vaccination coverage estimates for most vaccines among adolescents aged 13–17 years. Model-based vaccination coverage estimates were notably lower for varicella, MMR, and Hepatitis B compared to NIS-Teen coverage estimates among adolescents. Trends in estimates of national vaccination coverage were similar between model-based estimates for children and adolescents as compared to NIS-Child and NIS-Teen, respectively. A hierarchical model applied to data from IIS may be used to estimate coverage for routinely recommended vaccines among children and adolescents and allows for timely analyses of childhood and adolescent vaccines to quickly assess trends in vaccination coverage across the United States. Monitoring real-time vaccination coverage can help promote immunizations to protect children and adolescents against vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Knowing the settings where children ages 5–17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5–17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. Among vaccinated children ages 5–11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12–17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12–17 years but minimally for children ages 5–11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. Children ages 5–17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We surveyed a diverse group of US participants to understand parental coronavirus disease 2019 (COVID-19) vaccine hesitancy. METHODS: We administered a telephone and online survey from May 7 to June 7, 2021 using stratified sampling to ensure robust sample sizes of racial and ethnic minorities. Of the 20,280 contacted, 12,288 respondents completed the survey (response rate 61%). We used chi-square tests and adjusted risk ratios to compare results by racial/ethnic group. RESULTS: Overall, 23% of parents stated that they plan to (or have) vaccinated their children; 30% said that they would not vaccinate their children, and 25% were unsure. Latino/a, Native American, and Asian American-Pacific Islander (AAPI) parents were generally more likely to vaccinate their children than Black or White parents. After adjusting for demographic factors, AAPI parents were significantly more likely to vaccinate their children than were others. Of parents who said that they would not vaccinate their child, 55% stated it was due to insufficient research. However, over half of parents stated that they would follow their child's health care provider's recommendations. After adjusting for demographic factors, trust in their primary care doctor was significantly lower among AAPI, Black, and Native American parents than White parents. CONCLUSIONS: Parental vaccine hesitancy was similar overall, but drivers of hesitancy varied by racial/ethnic groups. While the perception that vaccines had been "insufficiently researched" was a major concern among all groups, we found that parents are gen-erally inclined to follow health providers' recommendations. Health professionals can play an important role in COVID-19 vaccine education and should provide access to vaccines. [ABSTRACT FROM AUTHOR]

• Misbeliefs about the safety of vaccination predict adult hesitancy to COVID vaccines. • The same beliefs predict hesitancy for vaccinating children ages 5–11 against COVID. • Misbeliefs about COVID vaccines correlate highly with general concerns about vaccination. • Misinformation about vaccination in general is a barrier to uptake of COVID vaccines. Despite increasing rates of vaccination for COVID-19 in the US, hesitancy continues to be a barrier to the full immunization of the eligible population. Hesitancy appears to be particularly pronounced among adults deciding whether to recommend that children be vaccinated against COVID-19. In this research, we tested whether embrace of misinformation about the safety of vaccination is associated with hesitancy to vaccinate oneself and to recommend vaccination of a 5–11-year-old child for COVID-19. In a national probability panel created in April 2021, we assessed belief in both general vaccination misinformation and misinformation about COVID-19 vaccines, in particular. As hypothesized, belief in general vaccination misinformation predicted the uptake in reported vaccination among adults through September 2021, and likelihood to recommend COVID-19 vaccination of children aged 5–11 in January 2022, three months after the approval of that vaccine. In addition, misinformation about COVID-19 vaccines that arose over time correlated highly with more general vaccination misinformation. For both outcomes, general vaccine misinformation predicted vaccination hesitancy beyond concerns about the health risks of contracting COVID-19 for one's family and children ages 5–11. The findings indicate that continued efforts are needed to bolster beliefs about the safety of authorized and approved vaccines of many types and not just those for COVID-19. Some strategies to achieve this objective are suggested. [ABSTRACT FROM AUTHOR]

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk. Objectives The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children. Methods A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n  = 1497 and n  = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n  = 1183 and n  = 1322 for anemia and iron intake variables, respectively), aged 2–5 y, before and after the 2009 revisions. The NHANES 2003–2008 and 2011–2018 data represented the period pre- and post-2009 revisions, respectively. Results The 2009 package revisions were significantly associated with reduced probability of anemia (−4.3% points; 95% CI: −7.5, −1.1% points) and nonthalassemic microcytic anemia (−1.7% points; 95% CI: −3.3, −0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants. Conclusions This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States. [ABSTRACT FROM AUTHOR]

Poverty continues be most prevalent among young children under three years of age, when development, particularly in communication and language skills, is rapid and vulnerable to socioeconomic impacts. Home visiting was intentionally formulated to support parents in promoting children's development and health, offsetting poverty's threats. Little Talks, a parent-mediated intervention to promote children's communication and language growth, was designed for implementation in home visiting programs. Developed through community-partnership research methods, Little Talks is a modular intervention that is tailored to parents' styles and preferences for interacting with their children. A randomized control trial of Little Talks' effectiveness in attaining outcomes aligned with the two-generational processes inherent in home visiting was undertaken. Situated in an Early Head Start program, home visitors and the families they served were randomly assigned to receive EHS with Little Talks and typical EHS services. Assessed across four time points during a 10-month period, Little Talks was demonstrated to significantly enhance the quality of home visits and parents' involvement in their children's early learning experiences. In addition, parents' depressive symptoms did not increase as noted for the comparison condition. Communication and language growth improved for EHS Little Talks children, although statistical significance was not attained. Moreover, parenting outcomes were greatest for families who were less acculturated to US either by immigration status and/or language preferences. Implications advancing Little Talks as a feasible and effective addition to home visiting programs are offered. [ABSTRACT FROM AUTHOR]

• Youth aging out of foster care experience high rates of homelessness. • A federal law allowing states to extend foster to age 21 reduced rates of homelessness among 18–24 year-olds. • There was a lagged effect of states extending foster care on rates of homelessness. • There was no similar effect of states' extending foster care on rates of homelessness among those not ages 18–24. Youth aging out of foster care experience high rates of homelessness during young adulthood. This study assessed the impact of states' extension of foster care through age 21 under the federal Fostering Connections to Success and Increasing Adoptions Act of 2008 on state-level rates of homelessness among all youth ages 18–24, which we used as a proxy to assess impact on the legislation's target population. To do so, we leveraged data from the U.S. Department of Housing and Urban Development, the Census Bureau and several other publicly available data sources to construct a novel state-level panel dataset that allowed us to capture changes in rates of homelessness among youth ages 18–24 and extended foster care policies in all 50 states for the eight-year period from 2013 to 2020. Employing a difference-in-difference approach, we found evidence of an anticipated lagged effect of extended foster care, wherein the implementation of extended foster care is associated with a 23 % reduction in the total rate of youth homelessness four years later. This effect persists in years five to six after states adopt this policy change. We found no evidence of a similar effect of extended foster care on rates of homelessness among persons not between the ages of 18–24. Our findings provide important evidence about the impact of the Fostering Connections Act and suggest that extending the age of foster care eligibility may create important safety nets and pathways that support a reduction in rates of homelessness among former foster youth. [ABSTRACT FROM AUTHOR]

This study uses the bioecological model of human development and person-centered methods to describe the underlying patterns of risk and their association with bullying perpetration and victimization among U.S. children. Using the National Survey of Children's Health, this study (n = 7319) explored the underlying patterns of risks across six domains (i.e., individual, family, school, neighborhood, economic, and socio-cultural) associated with bullying perpetration and victimization among U.S. elementary school children. Latent Class Analysis uncovered four patterns of risks. The low risks group (72.4%) showed the lowest rates of bullying perpetration (24.6%) and victimization (57.2%). The individual and environmental risks group (15.3%) presented moderate levels of bullying perpetration (31.8%) and victimization (67.1%). The family risks group (8.3%) showed moderate levels of bullying perpetration (35.9%) and victimization (66.0%). High risks group (4.0%) presented exceptionally high rates of bullying perpetration (59.1%) and victimization (87.3%). Results suggest rates of bullying perpetration and victimization differed across the four patterns of risks. Understanding the sources of risk may be critical to alleviate bullying perpetration and victimization among children. Findings suggest that child bullying should be approached with customized treatment considering their pattern of risk exposure. • Four underlying risk patterns associated with bullying perpetration and victimization. • Bullying rates among U.S. children were 29% for perpetration and 61% for victimization. • Customized anti-bullying treatments should consider a child's risk pattern. [ABSTRACT FROM AUTHOR]

Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied. The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status. This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010. Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts. Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight). Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores. Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (β = –.07; 95% CI –.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46). A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children. [ABSTRACT FROM AUTHOR]

This study investigates the use of neurocognitive data collected via functional near infrared spectroscopy (fNIRS) for the development of predictive algorithms related to client Dialectical Behavior Therapy (DBT) skill use in Digital Counseling Environments (DCEs). Specifically, the aim of this study is to examine the utility of using neurocognitive data in combination with a machine learning algorithm to predict client selection of strategies in a virtual environment. Participants were recruited from a rural school located in the United States (n = 50). Student participants engaged in one of three DBT skill development conditions: time-delay-control, face-to-face, and virtual reality-based. Neurocognitive responses in the form of ratios of oxygenated and deoxygenated blood in neural tissue (hemodynamic response) were collected during the learning phase within each condition. The data was then used to train and develop a model to predict the success of client selection of DBT strategies when presented with the opportunity in an assessment phase. The average predictive accuracy of the resultant algorithm was ∼83%. Results also illustrated the potential to capture changes in cognition via hemodynamic response as they occur during DBT skill development in near real-time (∼300 ms). Findings from this study illustrate that the use of neurocognitive data in DCEs may be used to successfully predict client outcomes and increase the quality and reliability of counselor assessments of client progress, aid in the development of artificially intelligent counselors, and improve counselors use of client-based analytics in face-to-face and digital counseling environments. • Classification of neurocognitive data allows prediction of client outcomes by measuring fluctuations in cognition. • Describes neurocognitive data sources for development of predictive digital counseling platforms. • Hemodynamic responses help to understand levels of client attention and engagement in real-time. [ABSTRACT FROM AUTHOR]

Global trends toward childhood obesity have been associated with several factors, including suboptimal infant feeding practices, the increasing availability of ultraprocessed foods in the world's food supply, and the corresponding changes in children's dietary patterns. To describe infants' dietary patterns and assess their associations with weight status outcomes in a nationally representative sample of US infants. Cross-sectional analyses were performed on data collected from infants participating in the 2009-2018 National Health and Nutrition Examination Survey. Participants included 744 infants aged 6 to 12 months who had data from at least 1 day of valid 24-hour dietary recall data. Rapid weight gain and overweight/obesity risk. Principal component analysis was used to identify dietary patterns considering the energy intake of 39 Nova food subgroups (expressed in calories per day), including breast milk. Associations were evaluated using logistic regression adjusted for potential confounders. A total of 42% infants experienced rapid weight gain, and 33% were at risk of overweight/obesity. Most infants (65.5%) were started on solid foods early. Three main dietary patterns were derived. The first pattern, labeled Natural or Minimally Processed Foods, had positive loadings for a variety of natural or minimally processed foods, some processed culinary ingredients, and a few processed and ultraprocessed foods. The second pattern, labeled Infant Formula, had high negative loading for breast milk, and high positive loading for infant formula and breakfast cereal. The third pattern, labeled Ultraprocessed Foods, had negative loadings for natural or minimally processed foods and processed culinary ingredients, positive loadings for other processed foods and for a variety of ultraprocessed foods, and negative loading for infant formula. Infants who adhere to the Ultraprocessed Foods dietary pattern were more likely to present rapid weight gain (adjusted odds ratio 1.3, 95% CI 1.1 to 1.5) and overweight/obesity risk (adjusted odds ratio 1.2, 95% CI 1.0 to 1.4). Higher adherence to a dietary pattern characterized by ultraprocessed foods was associated with a greater likelihood of both rapid weight gain and overweight/obesity risk early in life. Promoting breastfeeding and increasing consumption of unprocessed/minimally processed foods during early infancy while restricting ultraprocessed foods are key components to reducing the growing burden of childhood obesity. [ABSTRACT FROM AUTHOR]

• Very few studies examined racial and ethnic disparities in the healthcare utilization of children in the U.S. foster care system. • Black children in foster care receive fewer routine and preventative check-ups but more frequently use medical services for treating chronic illnesses, compared to White children in foster care. • Black and Hispanic/Latine children in foster care are less likely to use both inpatient and outpatient mental or behavioral health services, compared to White children in foster care. • Additional race and ethnic differences exist in mental or behavioral healthcare utilization by specific service types and continuity of services over time. • Policy and programmatic recommendations include coordination between child welfare and healthcare systems to ensure that the health needs of children in foster care are met and for child welfare system change. Prior work has examined racial and ethnic disparities in the access to and utilization of healthcare services. However, evidence across studies is mixed, making it challenging to precisely identify where the racial and ethnic disparities in healthcare utilization are amongst children in foster care, and which race and ethnicity groups are most impacted by such disparities. As such, the purpose of the current study was to conduct a scoping review to synthesize evidence on the topic of racial and ethnic disparities in the physical and mental or behavioral healthcare utilization for children in the U.S. foster care system (PROSPERO ID: CRD42021272072). Comprehensive literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 414 studies identified, 23 met inclusion criteria: peer-reviewed journal article, published between 1991 and 2023, written in English, examined healthcare access or utilization of children in the U.S. foster care system as outcomes, included and disaggregated results by children's race and ethnicity, conducted quantitative analysis, and was observational in study design. In the physical healthcare utilization domain, Black children were less likely to utilize routine and preventative check-ups and more likely to utilize medical services for treating chronic illnesses such as asthma, compared to White children. In the mental or behavioral healthcare utilization domain, Black and Hispanic/Latine children were less likely to utilize both inpatient and outpatient mental health services, compared to White children. Furthermore, notable variations were observed by specific service types and continuity of services over time. Implications include additional research and education about racial and ethnic disparities in healthcare utilization amongst children in foster care, as well as implementing regulations and oversights that mandate racial equity in the child welfare and healthcare service pathways. [ABSTRACT FROM AUTHOR]

To examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity. Longitudinal cohort. A large US children's hospital. Caregiver–child dyads (n = 288 with complete data at 2 time points) were sampled in 2017–2019 from those who received care at Nationwide Children's Hospital. Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m2], overweight [BMI ≥ 25 and < 30 kg/m2], or obese [BMI ≥ 30 kg/m2]). Log-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers' eating competence and weight status. Eating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30–3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence. Although child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers' eating competence may translate into healthier behaviors and skills for caregivers and their children long term. [ABSTRACT FROM AUTHOR]

objective: To examine associations between adverse childhood experiences (ACEs) and age-specific insufficient sleep duration (ISD) in American youth. Methods: Data from the 2016-2017 National Survey of Children's Health, a sample of 46,209 youth ages 6 to 17 were analyzed. The main outcome was sleep duration that did not meet the recent recommendations of the American Academy of Sleep Medicine. Nine types of ACEs. as well as a cumulative count of ACEs, were examined as independent variables in unadjusted and adjusted logistic regression models. Results: Approximately half of U.S. children and adolescents (ages 6-17) experienced at least one ACE and a third did not get sufficient sleep. Among those exposed to any ACE. 40.3% had ISD. Seven of the 9 ACEs examined were significantly associated with a 20% to 60% increase in odds of not getting sufficient sleep (adjusted ORs between 1.2 and 1.6). Children exposed to 2 or more ACEs were nearly twice as likely as those exposed to no ACE to have ISD (adjusted OR = 1.7, 95% CI: 1.5-1.9). Moreover, each individual ACE, except parental death was significantly associated with more than 1 hour less sleep than recommended. Conclusions: This study reports the association of specific and cumulative ACEs with ISD in a nationally representative sample of American youth. The study findings underscore the importance of screening for both ACEs and insufficient sleep during primary care encounters and addressing potential sleep problems in those exposed to ACEs. [ABSTRACT FROM AUTHOR]

Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association of experiencing bullying within the past year with the prevalence of lifetime childhood asthma in U.S. children and adolescents; and whether this association varies with sex of the child and selected socioeconomic indicators.Methods: We performed secondary analyses using data from the 2018 National Survey of Children's Health participants aged 6 to 17 years (n=19,766). We used log-binomial regression to examine the association between bullying and lifetime childhood asthma before and after controlling for selected covariates. We also tested interactions of bullying with sex and selected socioeconomic indicators.Results: Children who experience bullying have a significantly greater probability of having asthma in adjusted analyses. The probability of childhood asthma increased with the frequency of bullying with prevalence ratios starting at 1.28 (95%CI:1.06, 1.55) for children bullied one to two times per year to 1.59 (95%:1.22, 2.09) for those being bullied at least four times per month. This association did not differ with sex of the child or selected socioeconomic indicators.Conclusions: We found that children who experienced bullying had a greater probability of having asthma relative to those who never experienced bullying. These findings highlight the impact of psychosocial stressors such as bullying as a nontraditional trigger in children with asthma. [ABSTRACT FROM AUTHOR]

BACKGROUND: Foreign-born Latino children in the United States (US) have poor asthma outcomes, but the role of routine care utilization in these outcomes is unclear. Our objective was to compare select ambulatory care utilization measures for asthma between foreign-born Latino, US-born Latino, and non-Hispanic white children. METHODS: Using a multistate network of clinics with a linked electronic health record, we compared the International Classification of Disease (ICD)-coded asthma diagnosis among those with respiratory symptoms, electronic health records documentation of diagnosis, prescriptions, and influenza vaccination of foreign-born and US-born Latino children, and non-Hispanic white children over a 10+ year study period. We also examined outcomes by country of birth in children from Mexico, Cuba, and Guatemala. RESULTS: Among our study population (n = 155,902), 134,570 were non-Hispanic white, 19,143 were US-born Latino, and 2189 were foreign-born Latino. Among those with suspicious respiratory symptoms, there was no difference between these groups in the predicted probability of an ICD-coded asthma diagnosis. US-born Latino children with asthma were less likely to have asthma documented on their problem list, more likely to have an albuterol prescription, and less likely to have an inhaled steroid prescribed. All Latino children had higher rates of influenza vaccination than non-Hispanic white children. CONCLUSIONS: In a national network, there were few disparities between Latino (US- and foreign-born) children and non-Hispanic white comparators in many common asthma care services, except some measures in US-born Latino children. Providers should understand that their US-born Latino children may be at elevated risk for not receiving adequate asthma care. [ABSTRACT FROM AUTHOR]

Background Complementary feeding (CF) provides an opportunity to shape children's future dietary habits, setting the foundation for good nutrition and health. Objectives We estimated effects of 3 CF behaviors on early childhood diet quality using inverse probability (IP) weighting of marginal structural models (MSMs). Methods Among 1041 children from the Boston-area Project Viva cohort, we estimated effects on the mean Youth Healthy Eating Index (YHEI) score in early childhood of 1) delayed (≥12 mo) compared with early (<12 mo) introduction of sweets and fruit juice; 2) continued compared with ceased offering of initially refused foods; and 3) early (<12 mo) compared with late (≥12 mo) introduction of flavor/texture variety. Mothers reported CF behaviors at 1 y and completed FFQs for children in early childhood (median age: 3.1 y). We estimated average treatment effects (ATEs) using IP weighting of MSMs to adjust for both confounding and selection bias due to censored outcomes and examined effect modification by child sex and breastfeeding compared with formula feeding at 6 mo. Results Twelve percent of mothers delayed introducing sweets/fruit juice, 93% continued offering initially refused foods, and 32% introduced flavor/texture variety early. The mean ± SD YHEI score was 52.8 ± 9.2 points. In adjusted models, we estimated a higher mean YHEI score with delayed (compared with early) sweets and fruit juice among breastfeeding children (ATE: 4.5 points; 95% CI: 1.0, 7.4 points), as well as with continued (compared with ceased) offering of refused foods among females (ATE: 5.4 points; 95% CI: 0.8, 9.1 points). The ATE for early (compared with late) flavor/texture variety was 1.7 points (95% CI: 0.3, 3.2 points) overall and stronger (2.8 points; 95% CI: 0.7, 5.1 points) among the formula-fed group. Conclusions Delayed introduction of sweets/juice, continued offering of refused foods, and early flavor/texture variety may all result in higher childhood diet quality. Effects may depend on child sex and infant breastfeeding status. [ABSTRACT FROM AUTHOR]

This study sought to examine children's immigration status as predictors of immigration related psychological distress and poverty among household with unauthorized parents. Immigration related psychological distress included stressors associated with working in United States without legal working papers and living in constant fear of deportation. Poverty was assessed by looking into income-to-needs ratio. Children's immigration status accounted for unique significant variance for poverty. The results indicated that households with unauthorized children were more likely to experience poverty than households with mixed-status children. Similarly, household with mixed status children were more likely to experience poverty than household with documented children. Although immigration-related psychological distress initially differed by children's immigration status, these differences disappeared after accounting for the income-to-needs ratio, highlighting poverty as a key factor in this distress. The findings that households with unauthorized parents, regardless of their children's immigration status, face higher poverty rates and that poverty drives immigration-related distress highlights the need for policies like DAPA, which could alleviate economic hardship and mental health challenges for these families. [ABSTRACT FROM AUTHOR]

Bullying is known to have negative impacts on students' mental, physical, and emotional health. As many as one in four students experience bullying at some point during the school year. These experiences of bullying can lead to lower academic performance, decreased attendance, and increased behavioral problems. Identifying, preventing, detecting, and responding to bullying cannot be addressed in isolation, as it takes a community approach to lessen the prevalence of bullying, and a critical component of this community is parents. Parental support and connectedness can help mitigate the adverse outcomes of bullying. This study examined parent perceptions of bullying in a majority Latinx urban school. Evidence suggests that bullying is a concern among minority groups as they are at greater risk for victimization in schools. Thus, this research examined how Latinx parents described bullying as it affects their children. This research utilized a skip-logic survey with quantitative and qualitative items to identify themes and patterns as to how Latinx parents defined bullying as it affects their children. The findings from this research denoted that a total of 52.9% of parents indicated that their child had been bullied at school. In this study, there was a clear difference in how the parents of male and female students described bullying experiences. Parents of females indicated that their child experienced verbal/relational bullying, while parents of male students referred to physical bullying. Implications for practice should focus on district efforts to promote collaboration between school and home to improve communication about bullying and expectations needed to identify, prevent, detect, and respond to bullying. Recommendations for future research should include longitudinal research with minority populations to better understand the impact bullying has on this community with unique needs. [ABSTRACT FROM AUTHOR]

• Critically reviews the literature on interventions to support children with incarcerated parents. • Twenty-four studies reporting on child outcomes in the United States were reviewed. • Most research has focused on promoting parenting skills and improving visits. • Little research on programs supporting at-home caregivers. • Services are typically not developmentally specified and do not acknowledge systems of inequality. The United States' overreliance on incarceration has resulted in the imprisonment of millions of individuals – the majority of whom are parents of minor children. While mass incarceration has failed to effectively reduce crime or increase safety, it has dramatically harmed children and families in the United States. In turn, a wealth of research confirms the negative social, emotional, and psychological impacts of parental incarceration on children and the disproportionate impact on Black and Hispanic families and families living in poverty. As activists work towards dismantling this discriminatory and overly punitive system, it is also necessary to support children and adolescents currently impacted by parental incarceration. Using the Family Stress-Proximal Process (FSPP) model (Arditti, 2016) as a frame, the current paper critically reviews the literature on interventions to support children with incarcerated parents (CIP). The use of the FSPP frame highlights that while most intervention research has focused on promoting parenting skills of incarcerated parents and improving visit experiences, there is a dearth of research on interventions that (1) support at-home caregivers, (2) provide developmentally-targeted and −appropriate services and (3) acknowledge and counteract systems of inequality like structural racism and poverty that cause and exacerbate incarceration-related stress. These findings support a research agenda that prioritizes interventions framed around the intersectional identities of CIP and the intersecting systems that impact their lives. [ABSTRACT FROM AUTHOR]

Unaccompanied children are a vulnerable group of immigrants who arrive to the United States (US) without a parent or caregiver. A growing body of research demonstrates that unaccompanied children experience trauma before, during, and after their arrival to the US. A gap in research in the US is a deeper understanding of how unaccompanied children describe the challenges they experience in resettlement, and what they perceive as most helpful as they adjust to new communities and social settings. This qualitative study is guided by the category fallacy theoretical framework and includes analysis of in-depth interviews with unaccompanied children who resettled in the US (n = 16). Findings reveal that unaccompanied children experience family separation and family reunification as distinct challenges. In addition, unaccompanied children perceive schools and social support as helpful with adjusting to new communities. The findings can inform how service providers design interventions and encourage policy makers to streamline school enrollment procedures. [ABSTRACT FROM AUTHOR]

Nearly a third of young US children take multivitamin/mineral (MVM) dietary supplements, yet it is unclear how formulations compare with requirements. Describe the number and amounts of micronutrients contained in MVMs for young children and compare suggested amounts on product labels to micronutrient requirements. Cross-sectional. All 288 MVMs on the market in the United States in the National Institutes of Health's Dietary Supplement Label Database in 2018 labeled for children 1 to <4 years old. Number of MVM products and amounts per day of micronutrients in each product suggested on labels compared with requirements represented by age-appropriate Daily Values (DV). Micronutrients of public health concern identified by the Dietary Guidelines for Americans (DGA) 2015-2020 (DGA 2015) and DGA 2020-2025 (DGA 2020) or those of concern for exceeding the upper tolerable intake levels. Number of products and percent DV per day provided by each micronutrient in each product. The 288 MVMs contained a mean of 10.1 ± 2.27 vitamins and 4.59 ± 2.27 minerals. The most common were, in rank order, vitamins C, A, D, E, B 6 , B 12 ; zinc, biotin, pantothenic acid, iodine, and folic acid. For micronutrients denoted by the DGA 2015 and DGA 2020 of public health concern, 56% of the 281 products containing vitamin D, 4% of the 144 with calcium, and none of the 60 containing potassium provided at least half of the DV. The upper tolerable intake level was exceeded by 49% of 197 products with folic acid, 17% of 283 with vitamin A, and 14% of 264 with zinc. Most MVMs contained many of 16 other vitamins and minerals identified in national surveys as already abundant in children's diets. A reexamination of the amounts and types of micronutrients in MVMs might consider formulations that better fill critical gaps in intakes and avoid excess. [ABSTRACT FROM AUTHOR]

No systematic, universally accepted method of diagnosing malnutrition in hospitalized patients exists, which may contribute to underdiagnosis, undertreatment, and poorer patient outcomes. To address this issue, the Academy of Nutrition and Dietetics is conducting a cohort study to: assess the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators for the diagnosis of adult and pediatric malnutrition in hospital settings; assess the interrater reliability of the indicators for the diagnosis of adult and pediatric malnutrition; and quantify the level of registered dietitian nutritionist care needed to improve patient outcomes. Up to 60 adult and 60 pediatric hospital sites will collect data to estimate level of registered dietitian nutritionist care, along with patient medical history and Malnutrition Screening Tool (adult) or STRONGkids (pediatric) results. A subset of 600 adult and 600 pediatric patients (∼1:1 screened as high- or low-risk for malnutrition) will be randomly selected for the indicators for the diagnosis of adult and pediatric malnutrition and Nutrition Focused Physical Exam data collection; 100 adult and 100 pediatric patients in this group will also undergo a bioelectrical impedance analysis measurement. Additional nutrition care and medical outcomes (eg, mortality and length of stay) will be collected for a 3-month period after the initial nutrition encounter. Multilevel linear, logistic, Poisson, or Cox regression models will be used to assess indicators for the diagnosis of adult and pediatric malnutrition validity and registered dietitian nutritionist staffing levels as appropriate for each medical outcome. Validation results will allow US clinicians to standardize the way they diagnose malnutrition in hospitalized patients, and the staffing data will support advocacy for available registered dietitian nutritionist-delivered malnutrition treatment to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens.Objectives: The present study provides a comprehensive time-trends analysis of added sugars intakes and contributing sources in the diets of US children, adolescents, and teens (2-18 years) from 2001-2018, focusing on variations according to sociodemographic factors (age, sex, race and ethnicity, income), food assistance, and health-related factors (physical activity level, body weight status).Methods: Data from 9 consecutive 2-year cycles of the NHANES were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001-2018 for the overall age group (2-18 years) and for 2 age subgroups (2-8 and 9-18 years). Trends were also examined on subsamples stratified by sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White), income (household poverty income ratio), food assistance, physical activity level, and body weight status.Results: From 2001-2018, added sugars intakes decreased significantly (P < 0.01), from 15.6% to 12.6% kcal among children (2-8 years) and from 18.4% to 14.3% kcal among adolescents and teens (9-18 years), mainly due to significant declines in added sugars from sweetened beverages, which remained the top source. Declines in added sugars intakes were observed for all strata, albeit to varying degrees.Conclusions: Declines in added sugars intakes were observed among children, adolescents, and teens from 2001-2018, regardless of sociodemographic factors, food assistance, physical activity level, or body weight status, but variations in the magnitudes of decline suggest persistent disparities related to race and ethnicity and to income. Despite these declines, intakes remain above the DGA recommendation; thus, continued monitoring is warranted. [ABSTRACT FROM AUTHOR]

Can the United States dramatically reduce the number of its children living in poverty? This article summarizes key conclusions of the report issued by National Academies of Sciences, Engineering and Medicine's Committee on Building an Agenda to Reduce the Number of Children in Poverty by Half in 10 Years. These conclusions focus on the causal evidence linking poverty reduction and child well-being as well as a host of policy and program ideas directed toward poverty reduction. The Committee found that packages of work-oriented and income support program are able to simultaneously reduce child poverty and increase the number of adult workers in low-income families. Costs of these policies are also considered. [ABSTRACT FROM AUTHOR]

Although they are an increasing share of the US child population (26% in 2020) and have much higher poverty rates than children in nonimmigrant families (20.9% vs 9.9%), children in immigrant families have much more restricted access to the social safety net, which can lead to increased economic hardship and health and developmental risks. More than 90% of children in immigrant families are US citizens, but they are excluded from the safety net due to restrictions that affect their parents and other family members. Exclusions that affect children in immigrant families include restricted categorical eligibility based on immigrant status, stricter income eligibility, reduced benefit levels, high administrative burden, and interactions with immigration policy such as public charge. These exclusions limit the ability of both existing and enhanced social programs to reduce child poverty among this population. Results derived from the Transfer Income Model simulations for the National Academy of Sciences, Engineering and Medicine's 2019 report A Roadmap to Reducing Child Poverty show that the poverty-reducing effects of potential enhancements to three main antipoverty programs result in unequal poverty reduction effects by family citizenship/immigration status with disproportionate negative effects on Hispanic children, 54% of whom live in immigrant families. Policy principles to improve equitable access and poverty-reduction effects of social programs for children in immigrant families include basing eligibility and benefit levels on the developmental, health and nutrition needs of the child instead of the immigration status of other family members, reducing administrative burden, and eliminating the link between immigration policy and access to the safety net. [ABSTRACT FROM AUTHOR]