Pediatrics Current Issue

Pneumococcal Pneumonia in Hospitalized Children: 2017–2023

Mon, 27 Apr 2026 00:00:00 GMT

10.1542/6389985742112Video AbstractPEDS-VA_2025-0731966389985742112

OBJECTIVES

We hypothesized that the incidence, clinical presentation, isolate serotypes, and isolate antibiotic susceptibility of Streptococcus pneumoniae causing pneumonia in children varied before and through the course of the COVID-19 pandemic.

METHODS

Patients aged 18 years or younger at 8 children’s hospitals in the United States admitted with culture-positive pneumonia were identified. Serotyping of pneumococcal isolates was performed at a central research laboratory. Clinical and laboratory data were collected retrospectively with a standardized case report form.

RESULTS

We identified 190 patients with pneumococcal pneumonia from 2017 to 2023. Cases decreased significantly in 2020 (P < .05), with a surge in 2022 and 2023. Serotype 3 was the most common serotype, was prominent after 2021, and was associated with a significantly higher rate of empyema and necrotizing parenchyma (P < .001). PCV13 serotypes 3, 19A, and 19F constituted over half of isolates; new serotypes in PCV15 (22F and 33F) and PCV20 (8, 10A, 11A, 12F, 15B, 22F, and 33F) accounted for 14% and 22% of isolates, respectively. Penicillin susceptibility (minimum inhibitory concentration [MIC] ≤ 2 μg/mL) was very common (94% of isolates), and all 11 isolates with MIC greater than 2 μg/mL were serotype 19A. Of those tested, 90 patients had viral coinfections; only influenza was associated with more pneumonia complications compared with patients without influenza (P = .002).

CONCLUSIONS

S pneumoniae remains an important cause of pneumonia in children with the potential for severe infections. After 2020, increasing rates have primarily been due to serotype 3, while β-lactam resistance was largely associated with serotype 19A. PCV15 and PCV20 may modestly reduce pneumococcal pneumonia incidence further.

Framework for Approaching Healthy Mental and Emotional Development in Pediatrics: Clinical Report

Mon, 27 Apr 2026 00:00:00 GMT

Despite widespread recognition that mental and emotional concerns in childhood have risen to an unprecedented high, there continues to be a sense of hesitancy in approaching mental and emotional development in pediatrics. This hesitancy is related to pervasive barriers including lack of comfort, time, and perhaps most importantly, lack of resources to offer families. However, research supports that families benefit from interventions that foster healthy relationships and whole health throughout development, which are fundamental to pediatric practice. Pediatricians are skilled in addressing whole health as they support the physical, mental, emotional, developmental, and social well-being of families from the birth of a child to their transition into adulthood. They are also accustomed to assessing health on a spectrum that includes prevention, early identification, treatment, and support as they work through concerns and diagnoses with families in an iterative manner and over the long-term. This type of practice that focuses less on expeditiously arriving at diagnoses and narrow treatments for concerns is important for mental and emotional development. This report presents a reframe of mental and emotional development as part of whole health as opposed to a condition that should only be diagnosed and treated when something is “wrong.” The report also provides a stepped approach that may be helpful for addressing mental and emotional health concerns in pediatrics and acknowledges the advocacy that is needed to expand mental and emotional resources widely.

Pneumococcal Pneumonia: Understanding the Past to See the Future

Mon, 27 Apr 2026 00:00:00 GMT

In this issue of Pediatrics, Engstrom et al¹ use data from a unique resource, the US Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG), to provide insight into the contemporary epidemiology of pneumococcal pneumonia in children. Given marked changes in respiratory pathogen epidemiology during and after the COVID-19 pandemic, as well as the availability of new multivalent pneumococcal conjugate vaccines (PCVs), this work is both timely and clinically relevant.

Thyroid Monitoring After Intravascular Iodinated Contrast Media in Infants and Children Through 3 Years of Age

Mon, 27 Apr 2026 00:00:00 GMT

In March 2022, the US Food and Drug Administration issued a drug safety communication (DSC) recommending monitoring of thyroid function in children up to 3 years of age who receive intravascular injection of iodinated contrast media (IV ICM) for medical imaging. In response, a group of pediatric and imaging experts convened to review the current scientific evidence on thyroid dysfunction after IV ICM and to provide recommendations on thyroid testing and management after IV ICM administration in infants and children. There are considerable gaps in knowledge related to the risk of thyroid dysfunction in young children exposed to IV ICM, and we strongly recommend that high-quality prospective studies be proposed and funded to clarify the incidence, risk modifiers, natural history, and outcomes of thyroid dysfunction after IV ICM exposure in this population.

Emergency Department Prescribing and Opioid-Related Harms Among Adolescents in Alberta: 2010-2020

Fri, 24 Apr 2026 00:00:00 GMT

BACKGROUND AND OBJECTIVES

Although emergency department (ED) prescribing is targeted as a potential contributor to opioid-related harms, the impact of efforts to curb prescribing and subsequent harms are poorly understood. We examined how rates of ED opioid prescribing and subsequent opioid-related harms have changed over time among adolescents.

METHODS

We conducted a cohort study using linked administrative data sets of patients aged 12 to 17 years who were discharged from any ED in Alberta, Canada, from April 1, 2010, to June 30, 2020. Opioid prescription fills in the 3 days after an ED visit were included. Our primary outcome was the development of opioid-related harms: a 1-year composite of opioid-related ED visit, opioid-related hospitalization, and opioid agonist therapy prescription. Joinpoint regression was used to identify changes in rates.

RESULTS

Among 1 197 829 ED visits, ED opioid prescribing decreased from 3.3% of visits in 2010 to 1.2% in 2020; specifically, codeine and oxycodone prescribing decreased while tramadol and other opioid prescribing increased. General EDs prescribed more opioids than pediatric EDs (2.5% vs 1.5%) and saw slower decreases over time. The development of opioid-related harms increased from 0.15% in 2010 to 0.28% in 2020.

CONCLUSIONS

During a decade when ED opioid prescribing to adolescents decreased substantially, subsequent opioid-related harms nearly doubled in Alberta. Broad deprescribing measures in the ED may not effectively combat the opioid epidemic in this province. However, caution should remain for patients with longer prescription durations, frequent ED use, and mental health or substance use comorbidity and further studies are needed to better delineate patient-level risk.

Correction to Postnatal Cord Blood Sampling: Clinical Report

Fri, 24 Apr 2026 00:00:00 GMT

Kaufman DA, Lucke AM, Cummings JJ; American Academy of Pediatrics, Committee on Fetus and Newborn. Postnatal Cord Blood Sampling: Clinical Report. Pediatrics. 2025;155(6):e2025071811

Incidence and Severity of Type 1 Diabetes in Children Through the COVID-19 Pandemic in Chile

Thu, 23 Apr 2026 00:00:00 GMT

10.1542/6388486816112Video AbstractPEDS-VA_2025-0721916388486816112

BACKGROUND AND OBJECTIVE

An increase in type 1 diabetes (T1D) incidence and severity was reported worldwide during the COVID-19 pandemic. The objective is to analyze whether this also occurred in the Chilean population aged less than 20 years.

METHODS

A population-based analysis was performed with people aged less than 20 years with T1D from a nationwide registry (2007–2023). Annual and quarterly incidence rates were calculated. Incidence rate ratios were used to compare averages by sex, age groups, and season. A seasonal autoregressive integrated moving average (SARIMA) model was used to predict incidence rates from 2020, comparing them with actual rates. An individual pre-post analysis was also performed with patients aged less than 18 years with T1D from 3 tertiary centers (2016–2023). Diabetic ketoacidosis (DKA) proportions were compared with Fisher’s exact test between 2016–2019 and 2020–2023.

RESULTS

This study included 9583 individuals. T1D incidence increased from 7.4 cases in 2007 to 13.9 cases in a population of 100 000 aged less than 20 years in 2023. Average incidence rates were significantly higher in the 10- to 14-year age group and in winter. Actual quarterly rates were significantly higher than those SARIMA predicted from 2020 to 2021 and not significantly different from 2022 to 2023. Of 334 patients, 71% had DKA. A significant increase in DKA from 64.3% to 75.9% was found in 2020–2023 (P = .03).

CONCLUSIONS

This study includes relevant data after 2021 and regarding severity. A significant increase in T1D incidence was found during the COVID-19 pandemic, paired with a higher severity at onset, returning to the prepandemic trend afterward. A causal relationship may be argued.

Type 1 Diabetes Incidence in Youth in the Context of the COVID-19 Pandemic

Thu, 23 Apr 2026 00:00:00 GMT

In this issue of Pediatrics, Kutz et al report the incidence of type 1 diabetes (T1D) in youth younger than 20 years in Chile from 2007 to 2023.¹ They identified a wave-like pattern in the incidence of T1D following the onset of the pandemic. This began with an increase in 2020 and 2021 that exceeded previous predictions, before declining to predicted rates in 2022 and 2023. This finding is consistent with large registry data from several European countries, including Germany and Scotland, that report a significant but temporary increase in new T1D cases, that was followed by a return to pre-pandemic rates or even a decline below predicted levels, indicating a wave-like pattern.²^,³ Data from the Southern hemisphere provided by Kutz et al therefore confirm that this is a global phenomenon. This leads to the crucial question of whether this temporary peak is directly attributable to SARS-CoV-2 infections or whether other factors played a role.

SARS-CoV-2 Vaccination Before and During Pregnancy and Prevention of Infant COVID-19 Infection

Wed, 22 Apr 2026 00:00:00 GMT

10.1542/6388766477112Video AbstractPEDS-VA_2025-0730006388766477112

BACKGROUND

SARS-CoV-2 vaccination during pregnancy reduces COVID-19 risk in infancy. Whether maternal vaccination before pregnancy similarly protects infants against COVID-19 is unknown.

METHODS

We examined the effectiveness of maternal messenger RNA SARS-CoV-2 vaccination before and during pregnancy in preventing COVID-19 in infants aged 0–6 months born between July 1, 2021, and June 30, 2023, at Kaiser Permanente Northern California. Maternal vaccination status was categorized as vaccinated during pregnancy, during a prepregnancy interval (0–<3, 3–<6, 6–12, and >12 months prepregnancy), or unvaccinated. Secondary analyses examined the effectiveness of vaccination by trimester. COVID-19 was defined by positive SARS-CoV-2 PCR result or diagnostic code, and COVID-19–related hospitalizations were confirmed by medical record review. Vaccine effectiveness (VE) was examined by Cox regression models adjusted for maternal and infant characteristics, calculated as (1 − hazard ratio) × 100%.

RESULTS

Among 78 644 infants, 3648 (4.6%) had COVID-19 infection and 76 (0.1%) experienced COVID-19–related hospitalization before age 6 months. For the 4 prepregnancy vaccination intervals, estimates for VE against COVID-19 infection ranged from −14.9% (95% CI, −32.8% to 0.5%) for less than 3 months prepregnancy to 23.6% (−14.3% to 49%) for more than 12 months prepregnancy. VE anytime during pregnancy was 7.5% (−2% to 16.2%) against infant COVID-19 infection and 52.9% (11.1%–75.1%) against infant COVID-19–related hospitalization. Effectiveness of third-trimester vaccination was 19.2% (8.6%–28.6%) against infant COVID-19 infection and 64.6% (12.3%–85.7%) against infant COVID-19–related hospitalizations.

CONCLUSION

Maternal vaccination during the third trimester was protective against infant COVID-19 infections. Maternal vaccination during pregnancy, particularly during the third trimester, was effective against infant COVID-19–related hospitalizations. Vaccination before pregnancy did not protect infants.

Unmasking Adrenal Insufficiency: Adrenal Crisis Triggered by Influenza-Associated Encephalitis

Wed, 22 Apr 2026 00:00:00 GMT

Primary adrenal insufficiency, or Addison disease, can be caused by an autoimmune process and presents with poor growth, poor weight gain, nausea, vomiting, fatigue, and skin hyperpigmentation. During times of stress or illness, patients with untreated or insufficiently treated adrenal insufficiency are at risk for adrenal crisis progressing to hypotensive shock, lethargy, confusion, coma, and death. While primary adrenal insufficiency is reported as a rare cause of encephalopathy, and more rarely encephalitis in adults, it is not known to be associated with encephalitis in children. Here, we present a unique case of a female 17-year-old who presented with significant encephalopathy and magnetic resonance imaging findings consistent with acute leukoencephalopathy with restricted diffusion and who was ultimately found to be in adrenal crisis secondary to influenza-related encephalitis. Due to rapidly declining neurologic function and concern for infectious encephalitis, the new diagnosis of adrenal insufficiency was not initially identified. Less common electrolyte derangements, including hypercalcemia and hyperphosphatemia, also contributed to difficulties in diagnosis. After initiation of steroid replacement, the patient progressed to make remarkable functional progress. This case underscores the importance of navigating diagnostic uncertainty in complex pediatric care to improve patient outcomes. In addition, this case contributes to the growing literature of primary adrenal insufficiency in the pediatric patient and demonstrates the important role of glucocorticoids on neurologic function and calcium/phosphate metabolism.

Prevalence of Obesity and Diabetes for American Indian Children on the Northern Great Plains

Tue, 21 Apr 2026 00:00:00 GMT

10.1542/6389887024112Video AbstractPEDS-VA_2025-0725596389887024112

INTRODUCTION

In 2015, the Indian Health Service reported an obesity prevalence rate of 29.7% for American Indian/Alaska Native children aged 2 to 19 years. The purpose of these annual evaluations is to describe the prevalence of obesity, prediabetes, and diabetes for American Indian children living on one reservation in the Northern Great Plains.

METHODS

From 2019–2020 through 2022–2023, American Indian students in grades kindergarten through 11, with parental consent, were screened for height, weight, body mass index (BMI) percentiles, and hemoglobin A1c (HbA1c) levels. χ² tests were used to determine differences in BMI percentiles, HbA1c levels, sexes, and changes over time.

RESULTS

In school years 2019–2020 through 2022–2023, students with overweight or class I, II or III obesity ranged from 60.9% to 68.6%. The percentage of students with any class of obesity ranged from 41.8% to 50.3%. Students in every grade (kindergarten-11) and every age (6–17 years) had overweight and classes I, II, and III obesity; every age from 5 to 17 years had prediabetes. The percentage of students with a hemoglobin A1c level from 5.7% to 6.4% significantly increased from 4.7% to 9.9% (P = .001) in 2019–2020 through 2022–2023. Of students with a hemoglobin A1c level of at least 6.5%, 70% were male, 18.8% were diagnosed type 1 diabetes, and 81.2% were diagnosed with type 2 diabetes.

CONCLUSIONS

Prevalence of obesity among these American Indian students is higher than 2015 rates. Prediabetes rates suggest an increase in the incidence and prevalence of diabetes is possible for these children. Interventions are needed to decrease the disease burden.

The 39-Hour Life of Patrick Bouvier Kennedy and the Rise of Modern Neonatology

Tue, 21 Apr 2026 00:00:00 GMT

At 4:04 am on August 9, 1963, President John F. Kennedy waited silently in a dim basement corridor outside the hyperbaric oxygen chamber at Boston Children’s Hospital. He was exhausted, hollowed out by two sleepless nights and a mounting sense of foreboding. Earlier in the week, his administration had announced the signing of the Limited Nuclear Test Ban Treaty, a notable milestone in Cold War arms control.¹ But on that dark morning, geopolitics felt impossibly distant. Just beyond the chamber’s steel walls, the President’s newborn son was dying.

Outcomes in Adolescents From Sequential vs Bilateral Cochlear Implantation in Young Children

Mon, 20 Apr 2026 00:00:00 GMT

OBJECTIVE

To investigate whether early simultaneous vs sequential bilateral cochlear implantation affects long-term hearing outcomes into adolescence and early adulthood.

METHODS

In this cross-sectional study, we compared performance in sound localization and speech recognition in quiet and in masking speech between adolescents with simultaneous or sequential bilateral cochlear implantation using linear mixed modeling. Participants were required to be aged 12 to 21 years, have received at least 1 cochlear implant before age 2.5 years, have an interval between the first and second cochlear implantation less than 4 years, attend a standard school curriculum, and have no cochlear malformation. Fifteen adolescents with normal hearing provided normative data.

RESULTS

Of 109 individuals from the Karolinska University Hospital medical records who were eligible based on the age and age at implantation criteria, 37 (34%) met all inclusion criteria and were willing to participate. Simultaneously implanted participants (n = 17) achieved higher sound localization accuracy than those who were sequentially implanted (n = 20) (P < .001; Cohen’s d = 0.58), whereas recognition of speech was comparable. Because both implant groups were consistent users of bilateral implants for on average 15 years, the interimplant delay was short for participants with sequential implants (mean = 1.2 years; 95% confidence interval, 0.29–3.5 years), and the groups were similar on a large number of social, environmental, and auditory factors before and after implantation; the higher localization accuracy is likely the result of simultaneous implantation. Both implant groups performed worse than adolescents with normal hearing.

CONCLUSION

Simultaneous bilateral cochlear implantation in early childhood supports better long-term spatial hearing than sequential implantation.

Preparation for Pediatric Emergencies in the Office: Technical Report

Mon, 20 Apr 2026 00:00:00 GMT

Medical emergencies in the pediatric office setting are infrequent but high-stakes scenarios. Advanced preparation will ensure that children who experience emergencies in the pediatric office receive optimal care and improved clinical outcomes. Optimizing pediatric office readiness for emergencies requires consideration of the unique aspects of each office practice, the types of patients and emergencies that might be seen, the resources available on site, and the resources of the larger emergency care system of which the pediatric office is a part. Important aspects of readiness include conducting an office-based readiness assessment reviewing annually, establishing and maintaining emergency protocols, stocking essential equipment and medications, and training office personnel to recognize and respond to emergencies. The information and resources in this technical report can be used to facilitate provision of high-quality care when pediatric emergencies occur in the office setting.

Preparation for Pediatric Emergencies in the Office: Policy Statement

Mon, 20 Apr 2026 00:00:00 GMT

Although not common, pediatric emergencies present in the medical office setting, and offices that care for children and adolescents can prepare for these emergencies. Offices vary depending on their location and office setting, patient population, and distance to an emergency department or hospital. Consequently, these factors should be taken into account in the planning process. This statement updates the recommendations from the 2007 American Academy of Pediatrics (AAP) practice guideline “Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers.” An accompanying technical report contains explanations and evidence for these recommendations and can be found at https://doi.org/10.1542/peds.2026-076622. This policy statement and companion technical report can be used as a guide to help create an individualized approach to emergencies that occur in offices that care for children, including both primary care and subspecialty practices. An accompanying checklist summarizes steps that medical offices can take to assess their readiness for pediatric emergencies.

The Neurodevelopmental Importance of the Timing of Bilateral Cochlear Implantation

Mon, 20 Apr 2026 00:00:00 GMT

In the United States, pediatric cochlear implantation (CI) is increasingly recognized as a time-sensitive intervention; however, bilateral, simultaneous implantation for eligible candidates remains limited and variable.¹ Although simultaneous bilateral CI implantation is widely accepted as safe and effective,² a substantial proportion of children experience a period of unilateral auditory sensation during early childhood.¹ Critically, this period represents a sensitive developmental window when processes of binaural auditory wiring are being established.³ This variability in timing and symmetry of auditory access provides an important backdrop for understanding how early clinical decisions intersect with sensitive, neurobiological periods and long-term auditory outcomes.

Cross-Language Qualitative Child Health Research: A Systematic Review

Fri, 17 Apr 2026 00:00:00 GMT

CONTEXT

An increasing number of US children have parents who prefer languages other than English (LOEs). However, many LOE families are excluded from participation in qualitative research because of English proficiency requirements. Guidance to promote inclusion of LOE populations in qualitative research is limited.

OBJECTIVE

To synthesize published child health cross-language qualitative research and examine trends in how studies are conducted when a language barrier exists between researchers and participants.

DATA SOURCES

PubMed, CINAHL, and Sociological Abstracts.

STUDY SELECTION

US-based cross-language research studies published between January 2010 and July 2025 that included adult LOE caregivers and discussed child health topics.

DATA EXTRACTION

Two reviewers examined each manuscript to describe cross-language processes for handling qualitative data collected with LOE participants, including study design/preparation, data collection, and analysis.

RESULTS

Fifty-two studies were included. Most studies included only Spanish-speaking participants. Studies covered a wide range of health issues and populations. Studies used varying procedures to obtain information from LOE caregivers. Most studies conducted qualitative analysis in English after translating interviews from the source language. Many relied on bilingual research study staff or community members. Few described how findings were disseminated back to the community of interest.

LIMITATIONS

Cross-language qualitative child health research has increased in recent years; best practices for handling language data in LOEs might be emerging.

CONCLUSIONS

This review identified variability in methods in published qualitative cross-language child health research. We share recommendations to promote inclusive practices in cross-language qualitative research to improve the generalizability and quality of child health research in the United States.

Hepatitis B Vaccination at Birth: Safety, Effectiveness, and Public Health Benefit

Fri, 17 Apr 2026 00:00:00 GMT

10.1542/6389577601112Video AbstractPEDS-VA_2025-0757836389577601112

Since 1991, the CDC has recommended screening for hepatitis B virus (HBV) infection in pregnancy and universal hepatitis B vaccination of all medically stable infants at birth, serving as a core strategy to prevent perinatal and postnatal infection and eliminate HBV transmission nationwide. On December 5, 2025, the Advisory Committee on Immunization Practices (ACIP) voted (1) among women who screen negative in pregnancy, parents decide, in consultation with providers, when or if to vaccinate their child for hepatitis B, and if not at birth, then aged no earlier than 2 months, and (2) consider collection of infant immune titers to guide decision-making for completing the vaccine series. We conducted a comprehensive review of the evidence on the safety, immunogenicity, efficacy, and effectiveness of the birth dose and a delayed first dose, and of the potential role of serology for clinical decision-making. We analyzed studies of the epidemiology of HBV infection, clinical trials, systematic reviews, vaccine safety from surveillance and clinical studies, and the potential impact of revised guidelines on individual and public health. We synthesized the history of ACIP recommendations and resulting trends in HBV incidence. The review found strong evidence for the safety and effectiveness of the birth dose, and no improvement in safety or effectiveness with a delayed first dose. We found no evidence to support the use of postvaccination serology. Infant vaccination has resulted in a 99% reduction in pediatric HBV infections; we found no evidence to support a change in vaccine recommendations but identified potential health consequences.

Using Quality Improvement to Reduce Loss to Follow-Up in Pediatric Patients With Type 1 Diabetes

Thu, 16 Apr 2026 00:00:00 GMT

BACKGROUND

Quarterly diabetes clinic visits are recommended for pediatric patients with type 1 diabetes (T1D). Lower rates of clinic visit attendance are associated with higher hemoglobin A1c (HbA1c) levels. We aimed to reduce the proportion of patients younger than 18 years with T1D who were lost to follow-up (LTFU) from a baseline of 38% to 20% in 18 months.

METHODS

A multidisciplinary team consisting of endocrinologists, clinic leadership, and program managers reviewed the existing scheduling process and created a driver diagram for improvement. LTFU was defined as the last clinic visit being more than 6 months prior. Multiple Plan-Do-Study-Act (PDSA) cycles were conducted to evaluate quality improvement (QI) interventions that included same-day scheduling of return visits by medical assistants, online scheduling via patient portal, and identification of and focused outreach to the LTFU cohort. The proportion of patients LTFU was analyzed monthly via statistical process control charts (p-charts). Planned data disaggregation by patient demographics and HbA1c levels was used to ensure existing disparities did not worsen.

RESULTS

We successfully reduced the proportion of patients LTFU from 38% to 15% by 18 months, and improvement was sustained at 27 months. Improvement in the proportion LTFU was seen across different patient demographics (eg, age, sex, race and ethnicity, language for care, health insurance) and HbA1c categories (<7%, 7%–9%, ≥9%) with a reduction in existing disparities.

CONCLUSIONS

Using a PDSA QI framework, simplifying the visit scheduling process and implementing changes in small, iterative cycles led to reduction in the proportion of pediatric patients with T1D who were LTFU.

Ending Do Not Resuscitate Requirements in Pediatric Home Hospice

Thu, 16 Apr 2026 00:00:00 GMT

Hospice care is designed to provide holistic support for children with serious illness while honoring family values and preferences. We recently encountered challenges in enrolling children from 3 of the 4 US census regions (the Midwest, West, and South) into home hospices. The hospice agencies maintained an internal policy requiring “Do Not Resuscitate” (DNR) orders as an enrollment requirement. We hold clinical and ethical concerns about pediatric hospice care being contingent on DNR orders.

Pedestrian and Bicyclist Crashes With Motor Vehicles by the Childhood Opportunity Index

Wed, 15 Apr 2026 00:00:00 GMT

10.1542/6389578604112Video AbstractPEDS-VA_2025-0752216389578604112

BACKGROUND

Neighborhood socioeconomic context influences pediatric injury risk, yet few studies apply child-focused metrics to quantify disparities in pedestrian and bicyclist crashes. We hypothesized that lower childhood opportunity would be associated with higher crash incidence and more severe and hazardous crash characteristics.

METHODS

This retrospective study examined pedestrian and bicyclist crashes involving children aged 0 to 17 years using Florida Signal Four Analytics (2015–2023) and the National Fatality Analysis Reporting System (2012–2023). The primary exposure was the crash zip code’s Child Opportunity Index quintile. Florida crashes were used to estimate incidence, with national fatality data analyzed for replication. Incidence was modeled using negative binomial regression to estimate incidence rate ratios (IRRs) and 95% CIs. Injury severity and crash-level characteristics were assessed using logistic regression.

RESULTS

A total of 18 272 crashes (49.6% pedestrian, 50.4% bicyclist) were identified; more than 60% occurred in low- or very low-opportunity neighborhoods. Incidence increased stepwise as opportunity declined (very low vs very high IRR 1.35 [95% CI 1.21–1.51]). Nationally, 3612 pediatric fatalities showed a similar pattern (very low vs very high IRR 2.82 [95% CI 2.65–3.00]). Very low-opportunity neighborhoods had higher odds of incapacitating injury (adjusted odds ratio [aOR] 1.71, 95% CI 1.34–2.16) and of improper actions (aOR 1.48, 95% CI 1.31–1.67).

CONCLUSIONS

Lower neighborhood opportunity is associated with higher pediatric pedestrian and bicyclist crash incidence, more severe injuries, and more hazardous crash contexts, supporting targeted prevention efforts in disadvantaged communities.

Unexpected Death in a Young Child With Cogan Syndrome

Wed, 15 Apr 2026 00:00:00 GMT

A 4-year-old child presented with a recent history of loss of appetite, weight loss, lower limb myalgias, fatigue, and new-onset hearing loss. These symptoms were associated with persistent microcytic anemia, leukocytosis, thrombocytosis, hypergammaglobulinemia, and elevated erythrocyte sedimentation rate. Major oncological, hematological, gastrointestinal, rheumatological, immunological, and infectious conditions were ruled out.Suspecting an autoinflammatory disease, high-dose corticosteroids were initiated but without clinical improvement. Due to the severe inflammatory state in the absence of autoimmune or infectious causes, anakinra was started, resulting in only transient benefit. The patient subsequently developed uveitis, and Cogan syndrome (CS) was suspected. Infliximab was administered but with no improvement. Treatment was then switched to tocilizumab, which led to both clinical and laboratory improvement.After 1 year of good disease control, the patient unexpectedly died. Autopsy revealed extensive involvement of the coronary and aortic vessels, with polymorphic inflammatory infiltrates.Cogan syndrome is a rare vasculitis that can affect vessels of all sizes, typically involving both the ocular and cochleovestibular systems. It is extremely rare in children, with only about 50 cases reported and just 2 deaths previously described.Unfortunately, there are no international guidelines for the treatment and follow-up of pediatric patients with CS. This case represents an uncommon manifestation of CS in a child and highlights the urgent need for evidence-based guidelines for the diagnosis, management, and long-term monitoring of these patients.

A Collaborative Initiative to Improve Anaphylaxis Management in Utah Schools

Wed, 15 Apr 2026 00:00:00 GMT

Food allergies are a significant public health concern in the United States. Fatality from food-induced anaphylaxis is associated with delayed administration of epinephrine. Utah children were at increased risk for school-related anaphylaxis due to a lack of school nurses, adequately trained staff, and a standardized approach to food allergy emergency management. In collaboration with the Utah School Nurses Association, the Utah Food Allergy Network, and the Utah Department of Health & Human Services, among other contributors, we aimed to accomplish the following goals: (1) develop and implement a web-based curriculum to train school staff to recognize and respond to anaphylaxis in school settings; (2) educate school officials on existing legal protections for layperson first responders; and (3) facilitate acquisition of unassigned epinephrine for use in schools through existing charitable pharmaceutical programs. From 2012 to 2023, our training program was completed 5759 times by individuals representing 421 Utah schools. The course was most frequently completed by teachers (n = 3006, 52.2%), office staff (n = 1480, 25.7%), and principals (n = 276, 4.8%). Since 2015, we have maintained an average year-to-year retention rate of greater than 68%. We observed a 245% increase in the number of schools with unassigned epinephrine. Due to this intervention, many Utah schools now prepare employees to administer epinephrine in the case of anaphylactic emergencies. Although school nurses play a significant role, their coverage is inadequate to meet the needs of all students at risk for anaphylaxis. Training volunteers to recognize and respond to anaphylaxis in school settings is needed to reduce delays in treatment and improve outcomes.

Variation in Suicide Risk Screening by Pediatricians Across Subspecialties

Tue, 14 Apr 2026 00:00:00 GMT

10.1542/6389805177112Video AbstractPEDS-VA_2025-0712086389805177112

OBJECTIVE

This study describes general and subspecialty pediatricians’ standardized suicide risk screening practices, variation in screening across subspecialties, and whether knowledge of the American Academy of Pediatrics (AAP) recommendations is associated with standardized suicide risk screening.

METHODS

We analyzed survey data from the 2023 American Board of Pediatrics Maintenance of Certification program. Survey items assessed use of standardized suicide risk screening tools, specific tools employed, adoption of universal screening approaches, and knowledge of AAP recommendations. Adjusted logistic regression examined associations between clinician characteristics and screening practices, and between knowledge of recommendations and screening.

RESULTS

Overall, 49.1% (5195) of eligible pediatricians responded, with 5003 included in the analysis. Standardized suicide risk screening was reported by 36.7% (1836), with emergency medicine physicians significantly more likely to report using standardized tools than general pediatricians (adjusted odds ratio [AOR] = 2.83; 95% CI: 2.13–3.77). Compared with pediatricians who reported that they were not at all knowledgeable of AAP recommendations, those who reported that they were moderately or very knowledgeable were significantly more likely to report standardized suicide risk screening (AOR = 1.53, 95% CI: 1.29–1.83). Among pediatricians who reported screening, 73.1% (1249) used a universal screening approach for children aged 12 years and older, with significant variation across subspecialties in the tools used.

CONCLUSIONS

Approximately 1 in 3 pediatricians reported using standardized suicide risk screening, with significant variability across subspecialties. Knowledge of AAP recommendations was associated with screening, suggesting that widespread dissemination of practice guidelines may increase implementation, particularly in subspecialty practices where early identification and timely interventions are less common.

Parent Knowledge of the US Tobacco 21 Law

Tue, 14 Apr 2026 00:00:00 GMT

Trends in Youth Mental Health Among Patients in Family Medicine Practices: 2017–2023

Mon, 13 Apr 2026 00:00:00 GMT

10.1542/6389815908112Video AbstractPEDS-VA_2025-0723056389815908112

OBJECTIVE

The burden of poor mental health among young people in the United States was rising before the onset of COVID-19. Prior research documents short-term increases in anxiety and depression in the wake of the pandemic, especially among older females. We study how the pandemic altered pre-existing trends in adolescent mental health and examine differential effects across demographic groups and time.

METHODS

We used electronic health record data from a national primary care practice registry to identify primary care visits with diagnoses for anxiety, affective mood disorders, attention-deficit hyperactivity disorder (ADHD), trauma and stressor-related disorders, behavior and conduct problems, and eating disorders. Using an interrupted time-series design, we compared changes in the level and slope of monthly visit rates before (January 2017–February 2020), during (March 2020–February 2021), and after (March 2021–December 2023) the first year of the pandemic.

RESULTS

Average monthly visit rates with anxiety diagnoses increased significantly between the pre- and postpandemic periods, especially among 12 to 17-year-old females (71% increase) and males (62% increase). Rates of mood disorder and ADHD diagnoses also increased among older females and remained significantly higher (35% and 8.5%) one year after the pandemic. Despite short-term increases, monthly rates began decreasing significantly in the postpandemic period.

CONCLUSION

The impact of the pandemic on pediatric mental health was heterogeneous across demographic groups and mental health conditions. Older adolescent females experienced persistently high levels of diagnosed ADHD, anxiety, and mood disorders, although there are signs of reversion to prepandemic levels.

Defining the Practice of the General Pediatrician: Entrustable Professional Activities Update

Fri, 10 Apr 2026 00:00:00 GMT

10.1542/6389579550112Video AbstractPEDS-VA_2025-0736476389579550112

The General Pediatrics Entrustable Professional Activities (EPAs) were created in 2013 to define the practice of the general pediatrician. Rooted in the needs of patients, the EPAs detail the essential tasks of practicing pediatricians and offer a framework for defining the expected outcomes of residency training. To support competency-based medical education and ensure graduates are prepared to meet the evolving needs of patients, the pediatrics community has committed to meaningfully incorporating the EPAs into training and certification and using them to guide curricula, individualize training, ground assessment, and determine readiness for practice. In support of this goal, a team of pediatricians, program directors, trainees, and public members assembled to review and update the General Pediatrics EPA framework. With input from volunteers and over 1000 program director and general pediatrician survey respondents, they revised the 17 original EPAs, consolidating the framework and ensuring each activity is clear, specific, and reflects contemporary practice. The resulting 12 revised EPAs and their essential cross-cutting knowledge, skills, and abilities were approved by the American Board of Pediatrics Board of Directors in June 2025. Here we describe the process undertaken to perform the first comprehensive revision of the General Pediatrics EPAs and highlight changes to content and language. By reviewing and revising the EPAs with broad and diverse input, we reaffirm these activities as the essential work of our specialty, providing a framework by which we can support a competency-based approach to training and lifelong learning focused on meeting the needs of children.

Communicating Constipation: Differential Diagnosis of Agitation in Autism at a Pediatric Hospital

Fri, 10 Apr 2026 00:00:00 GMT

Constipation is a common concern for youth with autism spectrum disorder (ASD). Many children with ASD also experience episodes of behavioral dysregulation; however, few studies have explored the relationship between constipation and dysregulation among youth with ASD, particularly for those with limited verbal communication ability. We present the case of a 14-year-old boy with ASD with accompanying language impairment, moderate intellectual disability, and longstanding gastrointestinal symptoms, including constipation and encopresis, who had an extended (120+ day) hospitalization in a quaternary care pediatric hospital while awaiting an inpatient psychiatric placement. Throughout his hospitalization, this patient presented with frequent and seemingly spontaneous episodes of behavioral dysregulation, characterized by self-injurious behavior, fecal smearing, and aggression toward others. The hospital’s inpatient board-certified behavior analyst tracked potential antecedents to these behaviors through the completion of a functional behavior assessment. This assessment demonstrated a relationship between frequency of stooling and occurrence of dysregulated episodes and prompted an increased focus on treatment of constipation. With aggressive treatment of his constipation, the frequency of his behavioral dysregulation decreased. This case highlights the value of conducting formal behavioral assessment within a hospital setting to determine the function of dysregulated behaviors, particularly for patients with communication deficits. This case also highlights the importance of conceptualizing dysregulated behaviors as potentially secondary to a medical concern that needs to be addressed before considering psychiatric hospitalization.

Enteric Viral Pathogens in Infants in the United States: 2017–2020

Thu, 09 Apr 2026 00:00:00 GMT

OBJECTIVE

The introduction of rotavirus vaccines in the United States led to substantial reductions in rotavirus disease burden, whereas the relative burden of other viral pathogens causing acute gastroenteritis (AGE) increased. Our aim was to establish the community-level burden of enteric viral pathogens in a US cohort during the first 2 years of life.

METHODS

From birth until age 2 years, weekly stools and AGE symptom surveys were collected from mother-child pairs in the PREVAIL (Pediatric Respiratory & Enteric Virus Acquisition and Immunogenesis Longitudinal) cohort. Stools were tested for 5 enteric viral pathogens, with infections defined by grouping proximal viral detections with the same genotype. Rates of infection and AGE symptoms were determined.

RESULTS

From 2017 to 2020, 245 children were followed, with 13 944 stools tested and 836 episodes of AGE recorded. Children had 3.8 enteric viral infections per child-year and over two-thirds had 1 or more symptomatic enteric viral infection by age 2 years. Norovirus Genogroup II (0.4 per child-year) and sapovirus (0.2 per child-year) had the highest incidence of symptomatic infections, followed by astrovirus, rotavirus, norovirus Genogroup I, and adenovirus 40/41 (each ≤0.1 per child-year). Approximately two-thirds of enteric viral infections were asymptomatic, and 90% were not medically attended. Symptomatic infections were infrequent before age 6 months.

CONCLUSION

Our findings show the high burden of symptomatic enteric viral infections, particularly norovirus, as well as the high frequency of asymptomatic infections, thereby improving our understanding of the epidemiology and clinical manifestations of enteric viral infections in young US children.

Burden of Enteric Viral Infections Among United States Children in the Post–Rotavirus Vaccine Era

Thu, 09 Apr 2026 00:00:00 GMT

As enteric viruses are among the leading etiologies of pediatric acute gastroenteritis (AGE) worldwide,¹ deeper understanding of their epidemiology is critical to inform effective health care strategies. In this issue of Pediatrics, Cannon et al² present estimates on the community burden of enteric viruses in the Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) cohort study, performed from 2017 to 2020 in mother-infant pairs from birth to 2 years old in Cincinnati, Ohio, United States. This represents the first demonstration of the incidence of infection and AGE due to common enteric viruses in early childhood in a US birth cohort. By 2 years old, children had experienced an incidence of 3.8 enteric viral infections per child-year; among protocol-adherent families with relatively complete data collection, over two-thirds (71%) of children experienced at least 1 symptomatic enteric virus infection, and virtually all (97%) experienced any enteric virus infection by 2 years old. Norovirus GII was the leading cause of both asymptomatic infection and AGE—consistent with a large body of literature demonstrating its predominance as the leading etiology of pediatric AGE in the United States after live-attenuated oral rotavirus vaccine (LORV) introduction³^,⁴—which underscores the need for a norovirus GII vaccine to further reduce the burden of pediatric AGE. Similarly, these data highlight the burden of sapoviruses, the second leading cause of infection and AGE in this cohort, but whose impact have arguably been relatively underappreciated in the United States despite their prevalence in medically attended AGE in children.⁵^,⁶

Toward a Harmonized Bronchopulmonary Dysplasia Definition: An International Delphi Process

Wed, 08 Apr 2026 00:00:00 GMT

BACKGROUND AND OBJECTIVES

Bronchopulmonary dysplasia (BPD) is the most prevalent chronic respiratory complication of preterm birth and is associated with lifelong impairments. Multiple definitions are currently in use, creating variability in reported incidences and challenges in benchmarking. A harmonized definition is crucial for clinical care, research, and quality improvement. The objective of this international Delphi procedure was to identity key features of a BPD definition.

METHODS

Health care professionals involved in neonatal clinical care and research were invited via an open electronic link to participate in a 2-round Delphi survey. A steering group disseminated the initial invitation. In round 1, participants rated 18 statements regarding BPD definition features using a 5-point Likert scale. Round 2 provided feedback from round 1, with consensus defined as greater than 70% agreement on acceptance or rejection of key features.

RESULTS

Of 438 respondents, 351 (80.1%) completed both survey rounds. Although the 2001 National Institutes of Health definition was most commonly applied (66.4%), substantial variability in practice was reported. Most statements (72.2%) received median scores of 4 or 5 in the first round. Bronchopulmonary dysplasia definitions were primarily used for quality improvement (82.1%), prognostication of respiratory outcomes (81.5%), and as research outcomes (64.1%). In round 2, 13 of 18 statements achieved greater than 70% consensus. The strongest agreement emphasized that BPD definitions should be severity based, serve as benchmarks across centers, and predict long-term respiratory outcomes.

CONCLUSIONS

This international Delphi procedure identified key features for defining BPD. Results highlight the need for a harmonized, severity-based classification predictive of long-term outcomes and supporting consistency in clinical care, research, and benchmarking.

Advancing Equitable Inpatient Psychiatric Access for Children With Autism Spectrum Disorder

Wed, 08 Apr 2026 00:00:00 GMT

Improving Pediatric Respiratory Chest Radiograph Stewardship in a Statewide Network

Tue, 07 Apr 2026 00:00:00 GMT

OBJECTIVE

To investigate the impact of a multicomponent quality improvement (QI) and financial incentive program on chest radiograph (CXR) stewardship in children with asthma, bronchiolitis, and croup in a statewide emergency network.

METHODS

The Michigan Emergency Department Improvement Collaborative launched a multicomponent QI program in March 2019 to decrease routine CXR use in children with common respiratory conditions. A subset of sites elected to adopt this CXR use metric within a financial incentive program. We analyzed data from visits between May 2017 and April 2023 at 39 emergency departments (EDs). The primary outcome was overall CXR use as a proportion of ED visits for asthma, bronchiolitis, and croup. We aggregated performance monthly at the site level and used statistical process control charts to assess improvement trends. Changes in ED revisits for respiratory conditions within 72 hours and admission rates served as balancing measures.

RESULTS

A total of 114 238 respiratory visits were included. Network-wide CXR use decreased from 34.3% of all ED respiratory visits at baseline to 21.1%. In sites selecting CXR use as an incentive measure, CXR use decreased from 32.5% to 19.2%. Rates of ED revisits for respiratory conditions did not change from the pre- to postintervention period (3.4% vs 3.6%, P = .22), while admission rates increased only modestly (21.5% vs 22.5%, P < .001).

CONCLUSION

ED use of CXR in children with common respiratory conditions decreased statewide after implementation of a multicomponent QI initiative and incentive program, providing a potential framework for improvement in other health care systems.

Clinician Perceptions of the Impact of Switching HPV Vaccine Initiation to 9–10 Years

Tue, 07 Apr 2026 00:00:00 GMT

BACKGROUND AND OBJECTIVES

Although HPV vaccine initiation as early as aged 9 years has been recommended, most clinicians initiate at ages 11 to 12 years. We assessed clinician-reported impact of early initiation on parental responses and vaccine discussions.

METHODS

As part of an ongoing cluster randomized pragmatic trial across 31 Colorado and California pediatric practices, we allocated practices to switch HPV vaccine initiation to ages 9 to 10 years or to enhanced usual care (initiation at ages 11 to 12 years). All clinicians received online training on improving HPV vaccination; intervention arm clinicians also received training on initiating at ages 9 to 10 years. We surveyed all clinicians in both arms at 1, 6, 12, 18, 24, 30, and 36 months (all >80% response rates), and queried clinicians in the ages 9 to 10 years arm about vaccination at ages 9 to 10 vs 11 to 12 years.

RESULTS

Almost all intervention arm clinicians switched rapidly to the ages 9 to 10 years initiation; most control clinicians remained at ages 11 to 12 years. Parental concerns/questions, pushback, hesitancy, and adherence to recommendations did not differ significantly between study arms and were similar at ages 9 to 10 vs 11 to 12 years among intervention arm clinicians. Only about one-tenth of clinicians in both arms brought up sexual activity during HPV vaccine discussions; two-thirds in both arms indicated parents sometimes/often did. Intervention arm clinicians were more likely than controls to state discussions were shorter by a lot/little (55% vs 37%, P = .005) since study initiation.

CONCLUSIONS

Initiating HPV vaccination at ages 9 to 10 years instead of ages 11 to 12 years had little impact on parental questions/concerns, pushback, hesitancy, or clinicians’ ability to convince hesitant parents. Initiation at ages 9 to 10 years was perceived by clinicians to shorten HPV vaccine discussions.

Influenza Vaccine Effectiveness in European Primary Care Pediatric Practices: 2022–2024

Mon, 06 Apr 2026 00:00:00 GMT

OBJECTIVES

To estimate influenza vaccine effectiveness (VE) in the pediatric population (<18 years) attending primary care in the European Union and European Economic Area in 2022/2023 and 2023/2024.

METHODS

General practitioners swabbed and interviewed patients with acute respiratory tract infection. We conducted a test-negative case-control study and used logistic regression to estimate VE against any influenza and specific (sub)types, overall and by age group, and within the vaccine recommendation target group.

RESULTS

Among 10 368 children in 2022/23, 3286 (32%) tested polymerase chain reaction-positive for influenza virus; among 9270 children in 2023/24, 1567 (17%) tested positive. Influenza A(H3N2) and B predominated in 2022/23, and influenza A(H1N1)pdm09 in 2023/24. Among the test-negative controls, 17% were part of the vaccine recommendation target group in 2022/23 and 38% in 2023/24. In 2022/23, overall VE against any influenza was 68% (95% CI: 59–76); 57% (95% CI: 26–76) against influenza A(H1N1)pdm09; 54% (95% CI: 33–69) against influenza A(H3N2); 83% (95% CI: 74–90) against influenza B. In 2023/24, overall VE against any influenza was 71% (95% CI: 62–78); 75% (95% CI: 64–83) against influenza A(H1N1)pdm09; 40% (95% CI: 4–64) against influenza A(H3N2); and 92% (95% CI: 63–100) against influenza B. All VE estimates varied by age and vaccine recommendation target group.

CONCLUSIONS

In 2022/23 and 2023/24, more than two-thirds of vaccinated children were protected against primary care-attended influenza infection in Europe. Monitoring VE in children can help inform influenza immunization programs.

Pediatric Vaccine Effectiveness Against Influenza Hospitalization and Outpatient Visits: 2021–2024

Mon, 06 Apr 2026 00:00:00 GMT

10.1542/6389887532112Video AbstractPEDS-VA_2025-0739736389887532112

OBJECTIVES

Understanding the protection from influenza vaccines could help inform vaccine counseling, which might improve pediatric influenza vaccination uptake. We estimated vaccine effectiveness (VE) against influenza-associated hospitalization and outpatient visits during 3 influenza seasons (2021–2024).

METHODS

We used data from 7 US pediatric medical centers within the New Vaccine Surveillance Network. We included children aged 6 months to 17 years who were hospitalized or received outpatient care for acute respiratory illness (ARI). We estimated VE against influenza-associated hospitalizations and outpatient visits with subgroup analyses for each season, stratifying by health care setting, age, and influenza virus type/subtype/genetic clade.

RESULTS

Among 19 917 children with ARI, 2831 (14%) were positive and 17 086 (86%) were negative for influenza; 8523 (43%) were vaccinated, and 11 394 (57%) were unvaccinated. Vaccination uptake among children testing negative for influenza ranged from 44% to 51% by season. VE overall ranged from 34% to 60% across seasons, with the lowest VE estimates during 2021 to 2022. Effectiveness was 53% against influenza A/H1N1, 43% against A/H3N2, and 69% against B, with further variation by clade.

CONCLUSIONS

From 2021 to 2024, pediatric influenza VE ranged from 34% to 60%, and overall was effective at preventing influenza-associated hospitalizations and outpatient visits. Effectiveness was higher against influenza B and lower during the 2021 to 2022 season. Vaccine uptake was low among children, with only half or fewer receiving the influenza vaccine each season. Influenza vaccination is the best way to reduce the risk of influenza for children. Improved pediatric influenza vaccination uptake would prevent additional influenza-associated hospitalizations and outpatient visits.

The Meaning of Vaccine Effectiveness: Candid Communication About the Flu Shot

Mon, 06 Apr 2026 00:00:00 GMT

Seasonal influenza challenges the notion that only death and taxes are certain. Each fall and winter, those of us living in temperate climates gear up for influenza season, an annual inevitability that imposes a significant public health burden through illness, hospitalization, and death.¹ Even the global implementation of COVID-19 nonpharmaceutical measures only temporarily blunted the impact of influenza. By the 2021 to 2022 season,² we began to see the return of disease activity. Particularly severe influenza seasons, especially among children, followed in 2022 to 2023³ and 2023 to 2024, with 187 and 210 pediatric deaths reported in the United States,⁴ respectively. Notably, severe influenza extends beyond familiar respiratory complications, potentially affecting other organ systems, as well. Children can experience neurologic complications,⁵ such as the recently reported influenza-associated acute necrotizing encephalopathy. These individual and community impacts underscore the importance of our best protection against influenza complications: the annual influenza vaccine.

Public Housing Redevelopment and Childhood Obesity

Fri, 03 Apr 2026 00:00:00 GMT

10.1542/6389885378112Video AbstractPEDS-VA_2025-0742546389885378112

BACKGROUND AND OBJECTIVES

Childhood obesity disproportionately affects low-income and racial-ethnic minority communities that tend to also have poor housing quality and obesogenic neighborhood environments. Yet, evidence on “whole-of-community” interventions that simultaneously improve housing, and neighborhood built and social environments, remains limited. This study examines the early impacts of a decade-long redevelopment of Jordan Downs (JD), a low-income public housing community in Watts, Los Angeles. We assessed effects on children’s obesity 2 years in, when roughly one-third of the site was redeveloped with new housing and built- and social-environment improvements.

METHODS

Using longitudinal data on a cohort of 399 children from JD and a nearby comparison group without redevelopment, we conducted difference-in-differences analyses. Primary outcomes were overweight/obesity, body mass index (BMI) z score, waist circumference, and waist-to-height ratio. Secondary outcomes included self-reported dietary, physical activity, and sedentary behaviors.

RESULTS

JD children experienced lesser increase in overweight/obesity prevalence (14.7 percentage points [pp] lesser; 95% CI: 4.4–25.1), BMI z score (0.15 lesser; 95% CI: 0.02–0.32), waist circumference (5% less; 95% CI: 1%-9%) and waist-to-height ratio (3.9% less; 95% CI: 0.1–7.7) than the comparison group. JD children consumed fewer sugar-sweetened beverages (1.13 fewer times per day; 95% CI: 0.09–2.17) and were more likely to be physically active in the neighborhood (18.2 pp more; 95% CI: 0.4–36.9) than the comparison group.

CONCLUSIONS

JD redevelopment was associated with a significantly lower increase in childhood obesity prevalence within its first 2 years.

A Febrile Mystery: Atypical Helicobacter pylori in a Child Returning From an Endemic Region

Fri, 03 Apr 2026 00:00:00 GMT

Helicobacter pylori (H. pylori) is a bacterial infection with a high prevalence in resource-limited regions. H. pylori infection in children presents with nonspecific and variable clinical features, making diagnosis challenging. We describe a pediatric patient who presented with fever of unknown origin (FUO), anorexia, weight loss, and anemia. Despite an extensive evaluation, the etiology remained unknown until H. pylori testing. This case underscores the importance of including H. pylori in the differential diagnosis of children presenting with FUO, particularly those with recent travel to endemic areas, where exposure to more pathogenic strains may result in significant disease.

Cleaning Product–Related Injuries Treated in US Emergency Departments: 2007–2022

Thu, 02 Apr 2026 00:00:00 GMT

10.1542/6389811848112Video AbstractPEDS-VA_2025-0745516389811848112

OBJECTIVES

The objective was to comprehensively describe the patterns and trends of household cleaning product–related injuries among children treated in US emergency departments from 2007 to 2022.

METHODS

The National Electronic Injury Surveillance System database was used to examine cases of unintentional, nonfatal, household cleaning product–related injuries among children aged 5 years or younger.

RESULTS

An estimated 240 862 children aged 5 years or younger were treated in US emergency departments for household cleaning product–related injuries. Cleaning product types and containers associated with the most injuries were bleach (30.1%) and detergents (28.6%). Poisoning (64.0%), followed by chemical burn (14.1%) and dermatitis and/or conjunctivitis (11.2%) were the most common diagnoses. Injuries were most associated with detergent packets (33.0%), spray bottles (28.2%), and non-spraying containers (19.7%).

CONCLUSIONS

The consistently high number of household cleaning product–related injuries sustained by the youngest children and new products that have entered the marketplace in the past decade highlights the need for stronger product packaging standards, with emphasis on ensuring that spray bottles and other commonly accessible containers meet child-resistant packaging requirements. These findings underscore the urgent need for comprehensive prevention strategies that include safer packaging, public education, and environmental modifications to reduce children’s access to toxic household substances.

Prediction of Developmental Outcomes in Preterm Infants: A Systematic Review

Thu, 02 Apr 2026 00:00:00 GMT

10.1542/6388674791112Video AbstractPEDS-VA_2025-0735806388674791112

CONTEXT

Increased survival of very preterm children raises concerns about later outcomes. Prediction models for developmental outcomes can support perinatal decision-making.

OBJECTIVE

Summarizing prediction models for developmental outcomes after very preterm birth.

DATA SOURCES

Medline, Embase, Web of Science, and the Cochrane database were searched for publications up to June 2024.

STUDY SELECTION

All developed or externally validated prognostic models predicting developmental outcomes of infants born very preterm (<32 weeks) or with a very low birth weight (≤1500 g) were included.

DATA EXTRACTION

Data extraction and risk of bias (RoB) assessment were done independently and in duplicate by 2 researchers using the Prediction Model Risk of Bias Assessment Tool.

RESULTS

Thirty-eight publications were identified describing 99 (85%) newly developed models and 18 (15%) external validations of 11 different existing models. The most predicted outcome was a composite measure of neurodevelopmental impairment, with prediction horizons ranging from 18 months to 10 years after birth. RoB was high for all models, mostly because of concerns regarding outcome and data analysis.

LIMITATIONS

Because of a high RoB among all included studies, no recommendation for the most accurate prediction model could be provided.

CONCLUSIONS

Although many prediction models for developmental outcomes after preterm birth exist, external validation is rare, and RoB is high. Future research is needed to validate and, if needed, update existing models to support perinatal decision-making.

Fast MRI Compared With Head CT in Evaluating Pediatric Neurologic Emergencies

Wed, 01 Apr 2026 00:00:00 GMT

BACKGROUND AND OBJECTIVES

We aimed to compare outcomes of patients who received a limited-sequence brain magnetic resonance imaging (fast MRI) with those receiving head computed tomography (CT) scans in the emergency department (ED). It was hypothesized that fast MRI would have less missed pathology while not increasing length of stay (LOS).

METHODS

We conducted a planned subanalysis of a prospective cohort of children evaluated for new neurologic complaints. We compared children who underwent fast MRI at presentation (the exposure group) with 3 comparison groups of children who received a CT scan first. Participants were excluded if they had known trauma, ingestion, or metabolic disease. Two comparison participants were matched to each case and analyzed in 3 arms: random, age, and diagnosis grouping.

RESULTS

Of 191 children receiving fast MRI scans, 159 were found to be eligible. These children were compared with 636 eligible children who received CT scans. Time from arrival to completed imaging was similar (fast MRI: 142 minutes vs CT: 139 minutes). Hospital LOS was also similar (fast MRI: 47 hours vs CT: 45 hours). Follow-up imaging found that fast MRI had less missed pathology than CT (MRI: 1.8% vs CT: 8.5%). Fast MRI was found to have a higher sensitivity (MRI: 95.8% vs CT: 63.0%) and a higher negative predictive value (MRI: 98.2% vs CT: 91.5%).

CONCLUSIONS

This planned subanalysis found that fast brain MRI had less missed pathology, higher sensitivity, and higher negative predictive value without increasing ED or hospital LOS for patients presenting to the ED with general emergent neurologic complaints.

Vitamin K Deficiency Bleeding After Refusal: A Sentinel Event in a Misinformation Era

Wed, 01 Apr 2026 00:00:00 GMT

A previously healthy infant presented at several weeks of age with irritability and cutaneous bleeding. Laboratory testing demonstrated a profound coagulopathy with markedly prolonged prothrombin and activated partial thromboplastin times. Coagulation factor studies demonstrated the classic pattern of vitamin K deficiency, with significantly reduced vitamin K-dependent factors (II, VII, X) and preserved factor V and VIII. Neuroimaging demonstrated an intracranial hemorrhage. After parenteral phytonadione (vitamin K1), coagulation tests substantially corrected, consistent with vitamin K deficiency bleeding (VKDB). Despite escalation of care, the infant died. Intramuscular (IM) vitamin K prophylaxis had been refused at birth.