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ImportanceThe US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children's rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children's rights.ObservationsSeven findings about advancing children's rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children's rights. High-potential strategies for catalyzing advancement of children's rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children's movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.Conclusions and relevanceChildren's rights provide a powerful, synergistic framework for child health professionals-in partnership with youth and other leaders-to increase equity and protect the rights and well-being of all children in the US.

Children who spend more time outdoors are more physically active and have fewer behavioral problems than those who spend less time outdoors. No studies to date have evaluated physical activity and behavioral outcomes in an exclusively outdoor nature preschool setting. The aim of this study was to examine differences in objectively measured physical activity and child behavior in children attending a nature preschool compared to waitlisted controls. This cross-sectional pilot study was conducted in Seattle, Washington, in 2016. Children were 3-5 years of age (n=33) at the time of enrollment; parents or primary caregivers completed assessments. Children in the intervention group were enrolled at the nature preschool. The comparison group included children that were either waitlisted at the nature preschool, or were participating in a 2-hour nature-based outdoor enrichment class at the same location once per week. All children wore Actigraph accelerometers to measure moderate-to-vigorous physical activity (MVPA; primary outcome) for 5 days; parents completed the Strengths and Difficulties Questionnaire to assess child behavior (secondary outcome). Children in the control group engaged in 16 more minutes/day of MVPA compared to children attending the nature preschool (113 minutes, SD=24; 97 minutes, SD=16, respectively). No differences were found in MVPA during preschool hours (9 am to 1 pm). Parents of children attending the nature preschool reported wanting their children to engage in more active outdoor playtime compared to controls (206 minutes, SD=136; 150 minutes, SD=87, respectively). Actual self-reported active outdoor playtime was also higher for nature preschool participants compared to controls (233 minutes, SD=61; 67 minutes, SD=52, respectively). Parents of nature preschool participants were more comfortable with lower temperatures (21 degrees F, SD=12) for their children to play outdoors than control families (30 degrees F, SD=19). In summary, both children attending more traditional childcare environments and nature preschools had high levels of MVPA and parents of children in nature preschools were more tolerant of colder conditions for outdoor play.

To understand if and why guardians access their adolescent child's electronic health record patient portal account. Guardians of transgender and gender-diverse adolescents completed a survey regarding patient portal use. Descriptive statistics were used to describe items related to guardian access to adolescent portal accounts. Of 82 respondents, 37.8% indicated they had used their child's login to access the patient portal. Most indicated they accessed their adolescent's account because their child asked them to do so. Other common reasons included being worried they might miss important health information and not realizing there was a difference between patient and proxy accounts. Results of this study provide a more detailed understanding regarding guardian access to adolescent patient portals. Findings can be used to inform adolescent patient portal design and enrollment practices that protect adolescent confidentiality. [ABSTRACT FROM AUTHOR]

Objectives To characterize the complex interplay between multiple clinical conditions in a time-to-event analysis framework using data from multiple hospitals, we developed two novel one-shot distributed algorithms for competing risk models (ODACoR). By applying our algorithms to the EHR data from eight national children's hospitals, we quantified the impacts of a wide range of risk factors on the risk of post-acute sequelae of SARS-COV-2 (PASC) among children and adolescents. Materials and Methods Our ODACoR algorithms are effectively executed due to their devised simplicity and communication efficiency. We evaluated our algorithms via extensive simulation studies as applications to quantification of the impacts of risk factors for PASC among children and adolescents using data from eight children's hospitals including the Children's Hospital of Philadelphia, Cincinnati Children's Hospital Medical Center, Children's Hospital of Colorado covering over 6.5 million pediatric patients. The accuracy of the estimation was assessed by comparing the results from our ODACoR algorithms with the estimators derived from the meta-analysis and the pooled data. Results The meta-analysis estimator showed a high relative bias (∼40%) when the clinical condition is relatively rare (∼0.5%), whereas ODACoR algorithms exhibited a substantially lower relative bias (∼0.2%). The estimated effects from our ODACoR algorithms were identical on par with the estimates from the pooled data, suggesting the high reliability of our federated learning algorithms. In contrast, the meta-analysis estimate failed to identify risk factors such as age, gender, chronic conditions history, and obesity, compared to the pooled data. Discussion Our proposed ODACoR algorithms are communication-efficient, highly accurate, and suitable to characterize the complex interplay between multiple clinical conditions. Conclusion Our study demonstrates that our ODACoR algorithms are communication-efficient and can be widely applicable for analyzing multiple clinical conditions in a time-to-event analysis framework. [ABSTRACT FROM AUTHOR]

BackgroundThere is limited evidence in preschool children linking media use, such as television/video viewing and computer use, to obesity and adiposity. We tested three hypotheses in preschool children: 1) that watching > 2 hours of TV/videos daily is associated with obesity and adiposity, 2) that computer use is associated with obesity and adiposity, and 3) that > 2 hours of media use daily is associated with obesity and adiposity.MethodsWe conducted a cross-sectional study using nationally representative data on children, aged 2-5 years from the National Health and Nutrition Examination Survey, 1999-2002. Our main outcome measures were 1) weight status: normal versus overweight or at risk for overweight, and 2) adiposity: the sum of subscapular and triceps skinfolds (mm). Our main exposures were TV/video viewing (< or = 2 or > 2 hours/day), computer use (users versus non-users), and media use (< or = 2 or > 2 hours/day). We used multivariate Poisson and linear regression analyses, adjusting for demographic covariates, to test the independent association between TV/video viewing, computer use, or overall media use and a child's weight status or adiposity.ResultsWatching > 2 hours/day of TV/videos was associated with being overweight or at risk for overweight (Prevalence ratio = 1.34, 95% CI [1.07, 1.66]; n =1340) and with higher skinfold thicknesses (beta = 1.08, 95% CI [0.19, 1.96]; n = 1337). Computer use > 0 hours/day was associated with higher skinfold thicknesses (beta = 0.56, 95% CI [0.04, 1.07]; n = 1339). Media use had borderline significance with higher skinfold thicknesses (beta = 0.85, 95% CI [-0.04, 1.75], P=0.06; n = 1334)ConclusionWatching > 2 hours/day of TV/videos in US preschool-age children was associated with a higher risk of being overweight or at risk for overweight and higher adiposity-findings in support of national guidelines to limit preschool children's media use. Computer use was also related to higher adiposity in preschool children, but not weight status. Intervention studies to limit preschool children's media use are warranted.

Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability. Conclusion: This e-consult platform shows great promise in increasing PCP confidence providing gender-affirming care adolescents. More widespread utilization could help improve access to care and decrease specialty care referrals. [ABSTRACT FROM AUTHOR]

ObjectiveTo test the independent effects of television viewing in children before age 3 years and at ages 3 to 5 years on several measures of cognitive outcomes at ages 6 and 7 years.DesignUsing data from a nationally representative data set, we regressed 4 measures of cognitive development at ages 6 and 7 years on television viewing before age 3 years and at ages 3 to 5 years, controlling for parental cognitive stimulation throughout early childhood, maternal education, and IQ.ResultsBefore age 3 years, the children in this study watched an average of 2.2 hours per day; at ages 3 to 5 years, the daily average was 3.3 hours. Adjusted for the covariates mentioned earlier, each hour of average daily television viewing before age 3 years was associated with deleterious effects on the Peabody Individual Achievement Test Reading Recognition Scale of 0.31 points (95% confidence interval [CI], -0.61 to -0.01 points), on the Peabody Individual Achievement Test Reading Comprehension Scale of 0.58 points (95% CI, -0.94 to -0.21 points), and on the Memory for Digit Span assessment from the Wechsler Intelligence Scales for Children of -0.10 points (95% CI, -0.20 to 0 points). For the Reading Recognition Scale score only, a beneficial effect of television at ages 3 to 5 years was identified, with each hour associated with a 0.51-point improvement in the score (95% CI, 0.17 to 0.85 points).ConclusionsThere are modest adverse effects of television viewing before age 3 years on the subsequent cognitive development of children. These results suggest that greater adherence to the American Academy of Pediatrics guidelines that children younger than 2 years not watch television is warranted.