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  • Pediatrics
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  • 1
    Language: English
    In: Pediatrics, August 2013, Vol.132(2), pp.e500-1
    Description: * Abbreviations: ACE — : adverse childhood experience NESARC — : National Epidemiologic Survey on Alcohol and Related Conditions Since the landmark study on adverse childhood experiences (ACEs),1 there has been a growing interest in the relationship between ACEs and physical health. ACEs are associated with smoking, chronic obstructive pulmonary disorder, obesity, diabetes, cardiovascular disease, alcohol use, and liver disease in adults in a dose-dependent fashion. In the original study by Felitti et al,1 ACEs were more common that one might expect; although the majority reported 0 or 1 ACE, one-fourth of all respondents reported ≥2 ACEs. Physical punishment, by contrast, is nearly universal in the United States; ∼90% of preschool-age children were spanked in the last year.2 Three decades of research on physical punishment has shown with remarkable consistency that spanking children increases the risk of poor mental health, aggression, and delinquent and antisocial behavior; decreases the quality of the parent-child relationship, increases behavioral symptoms, and increases rates of physical-abuse victimization.3 Despite the recognized association between ACEs and physical health in adulthood, however, there have been no studies to our knowledge that have evaluated the relationship between physical punishment and physical health in adulthood. … Address correspondence to Rachel P. Berger, MD, MPH, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Child Advocacy Center, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: rachel.berger{at}chp.edu
    Keywords: Discipline ; Health Status Measurement ; Health Status Indicators ; Punishment ; Aggression -- Psychology ; Child Rearing -- Psychology ; Chronic Disease -- Epidemiology
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 2
    Language: English
    In: Pediatrics, September 2012, Vol.130(3), pp.e600-6
    Description: To describe measles vaccination patterns in a cohort of Swiss children aged up to 3 years insured with a single health insurer. A dynamic cohort study evaluating measles immunizations patterns in children born between 2006 and 2008 was conducted. Time-to-event analysis was used to describe timing of measles immunization. Effective vaccine coverage was calculated by using an area under the curve approach. In the study cohort, 62.6% of 13-month-old children were up-to-date for the first measles immunization (recommended at 12 months of age). Approximately 59% of 25-month-old children were up-to-date for the second measles immunization (recommended at 15-24 months of age). Most doses were delivered during months in a child's life when well-child visits are recommended (eg, 12 months of age). For second measles vaccine dose, accelerations in vaccine delivery occurred at time points for well-child visits during the months 19 and 25 of age but with lower final uptake than for the first measles vaccine dose. Until their second birthday, children in our cohort spent on average 177 days and 89 days susceptible to measles due to policy recommendations and additional delays, respectively. In a group of children aged 6 months to 2 years reflecting the age distribution in our cohort, effective vaccine coverage was only 48.6%. Timing and timeliness of measles immunizations influence effective population vaccine coverage and should be routinely reported in addition to coverage whenever possible. Proposed timing and relation of recommended vaccinations to well-child visits could be relevant aspects in optimizing measles vaccine coverage to reach measles elimination.
    Keywords: Immunity, Herd ; Immunization Schedule ; Measles -- Prevention & Control ; Measles Vaccine -- Administration & Dosage
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 3
    Language: English
    In: Pediatrics, November 2015, Vol.136(5), pp.825-7
    Description: * Abbreviations: CAN — : child abuse and neglect CECANF — : Commission to Eliminate Child Abuse and Neglect Fatalities CPS — : child protective services The death of any child is a tragedy. When that death is caused by abuse or neglect, sorrow is often coupled with anger: How could this have happened? More importantly, was this preventable? A federal commission, the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF), is working to turn anger into action to stop these tragedies.1 At least 1500 children die every year at the hands of those who are supposed to care for and protect them. We say “at least” because we do not have reliable data about the number of deaths from child maltreatment. There is no national standard for counting these deaths, and the data about child fatalities come from multiple sources that do not coordinate or share data. Most experts, including the US Government Accountability Office, believe that child abuse and neglect (CAN) fatalities are significantly undercounted.2,3 Recognizing that even 1 death from CAN is 1 too many, Congress passed the Protect Our Kids Act that created CECANF in 2012.4 CECANF, a 12-member panel appointed by the president and Congress, began its work in February 2014. Commissioners have 2 years to study the extent and causes of CAN fatalities and to submit a report to Congress that includes concrete recommendations for a national strategy to eliminate CAN fatalities. In June 2014, CECANF began a series of public hearings across the country. Commissioners reached out to experts from a broad range of disciplines. Local legislators, child welfare leaders, law enforcement officials, federal policy experts, data experts, … Address correspondence to Rachel P. Berger, MD, MPH, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: rachel.berger{at}chp.edu
    Keywords: Pediatrics ; Physician'S Role ; Child Abuse -- Mortality
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 4
    Language: English
    In: Pediatrics, 2015, Vol.136(5)
    Keywords: Child Abuse – Prevention ; Pediatricians – Practice ; Child Welfare – Management
    ISSN: 0031-4005
    Source: Cengage Learning, Inc.
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  • 5
    Language: English
    In: Pediatrics, October 2011, Vol.128(4), pp.753-61
    Description: To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine. We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently. We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone. There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation.
    Keywords: Constipation -- Therapy ; Dietary Fiber -- Therapeutic Use
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 6
    Language: English
    In: Pediatrics, January 2011, Vol.127(1), pp.e47-52
    Description: The goals were to assess the use of the skeletal survey (SS) to evaluate for physical abuse in a large consecutive sample, to identify characteristics of children most likely to have unsuspected fractures, and to determine how often SS results influenced directly the decision to make a diagnosis of abuse. A retrospective, descriptive study of a consecutive sample of children who underwent an SS at a single children's hospital over 4 years was performed. Data on demographic characteristics, clinical presentation, SS results, and effects of SS results on clinical diagnoses were collected. A positive SS result was defined as a SS which identified a previously unsuspected fracture(s). Of the 703 SSs, 10.8% yielded positive results. Children 〈6 months of age, children with an apparent life-threatening event or seizure, and children with suspected abusive head trauma had the highest rates of positive SS results. Of children with positive SS results, 79% had ≥1 healing fracture. This is the largest study to date to describe the use of the SS. Almost 11% of SS results were positive. The SS results influenced directly the decision to make a diagnosis of abuse for 50% of children with positive SS results. These data, combined with the high morbidity rates for missed abuse and the large proportion of children with healing fractures detected through SS, suggest that broader use of SS, particularly for high-risk populations, may be warranted.
    Keywords: Child Abuse -- Diagnosis ; Fractures, Bone -- Diagnosis
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 7
    Language: English
    In: Pediatrics, February 2016, Vol.137(2), pp.e20153059
    Description: We estimated associations between total amount of parental debt and of home mortgage, student loan, automobile, and unsecured debt with children's socioemotional well-being. We used population-based longitudinal data from the National Longitudinal Study of Youth 1979 Cohort and Children of the National Longitudinal Study of Youth 1979 Cohort. Our analytic sample consisted of 29 318 child-year observations of 9011 children and their mothers observed annually or biennially from 1986 to 2008. We used the Behavioral Problems Index to measure socioemotional well-being. We used ordinary least squares regressions to estimate between-child associations of amounts and types of parental debt with socioemotional well-being, net of a host of control variables, and regressions with child-specific fixed effects to estimate within-child associations of changes in parental debt with changes in socioemotional well-being, net of all time-constant observed and unobserved confounders. Greater total debt was associated with poorer child socioemotional well-being. However, this association varied by type of debt. Specifically, higher levels of home mortgage and education debt were associated with greater socioemotional well-being for children, whereas higher levels of and increases in unsecured debt were associated with lower levels of and declines in child socioemotional well-being. Debt that allows for investment in homes (and perhaps access to better neighborhoods and schools) and parental education is associated with greater socioemotional well-being for children, whereas unsecured debt is negatively associated with socioemotional development, which may reflect limited financial resources to invest in children and/or parental financial stress. This suggests that debt is not universally harmful for children's well-being, particularly if used to invest in a home or education.
    Keywords: Parents ; Socioeconomic Factors ; Child Behavior Disorders -- Epidemiology
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 8
    Language: English
    In: Pediatrics, February 2016, Vol.137(2), pp.e20150620
    Description: Hereditary angioedema (HAE) may manifest with swelling of the face, extremities, and upper airways. Gastrointestinal symptoms are also common and may include abdominal pain, vomiting, and diarrhea. However, pancreatic involvement is rare and has been reported only in a few adults with previously diagnosed HAE. We describe a 6-year-old boy who presented with recurrent severe abdominal pain accompanied by an elevation in pancreatic enzyme levels, without subcutaneous or cutaneous angioedema. His symptoms had begun 18 months earlier, and he was hospitalized several times before the present admission with a diagnosis of acute pancreatitis. More comprehensive analysis yielded low levels of C2, C4, CH50, and C1 esterase inhibitor, establishing the diagnosis of HAE. One year after diagnosis, swelling of the extremities appeared for the first time. This is the first report of a child in whom pancreatic disease was the presenting symptom of HAE. HAE should be included in the differential diagnosis of recurrent pancreatitis in children.
    Keywords: Angioedemas, Hereditary -- Diagnosis ; Pancreatitis -- Etiology
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 9
    Language: English
    In: Pediatrics, 02/2016, Vol.137(Supplement 3), pp.154A-154A
    ISSN: 0031-4005
    E-ISSN: 1098-4275
    Source: CrossRef
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  • 10
    Language: English
    In: Pediatrics, June 2013, Vol.131(6), pp.e1917-36
    Description: Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning). Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes. Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms. Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.
    Keywords: Adolescent Development ; Prenatal Cocaine Exposure ; Adolescent Development -- Drug Effects ; Cocaine -- Adverse Effects ; Cocaine-Related Disorders -- Epidemiology ; Prenatal Exposure Delayed Effects -- Epidemiology
    ISSN: 00314005
    E-ISSN: 1098-4275
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