Pediatri

To the Editor: On February 20, 2020, the incidence of Covid-19 began to rapidly escalate in Italy. By March 25, Italy had the second highest number of Covid-19 infections worldwide and the greatest number of deaths. Children younger than 18

This cross-sectional study informs public health and clinical practice by describing differences in demographic characteristics, substance use behaviors, and clinical characteristics of e-cigarette, or vaping, product use–associated lung injury (EVALI) among adolescents compared with adults.

Mood fluctuations are common during normal daily life as a result of either stressful or pleasant events. However, severe and persistent mood swings that result in psychological distress and behavioral impairment may be symptomatic of an underlying affective disorder. Affective

The World Health Organization (WHO) recommends 3 days of oral amoxicillin (80 mg per kilogram of body weight per day) in children younger than 5 years of age who have fast-breathing pneumonia (cough lasting Journal, two well-performed randomized, controlled trials

On presentation to the emergency department, patients with fever, tachypnea, rales on lung examination, and acid–base disturbances are often given a suspected diagnosis of viral infection, yet persons with salicylate toxicity may present with similar symptoms. This article highlights the

Presentation of Case. Dr. Rachel M. Erdil (Medicine and Pediatrics): A 7-year-old girl who had immigrated to the United States from Central America was evaluated in the asylum clinic of this hospital — where forensic medical evaluations of asylum seekers

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Coronavirus So many more questions, but at the same time so much knowledge gleaned in such a short time. COVID-19 continues appropriately to dominate the headlines but, while only weeks ago, most literature was in the realm of speculative, we

Embracing moral distress Trisha Prentice and colleagues’ leading article on moral distress is the Editor’s choice. It continues the theme from the May issue and is a worthwhile read for all involved in neonatal care. With improving outcomes in the

Although substantial progress has been made in many aspects of child health in the past two decades, the COVID-19 pandemic and its wide-ranging effects are threatening some of these hard-won gains. Public health measures such as lockdown, school closures, and

In early March, I was paged to evaluate a 13-month-old with a retropharyngeal neck abscess. She was a delightful child who had the misfortune of presenting to the hospital at the beginning of the Covid-19 crisis with fevers, upper respiratory

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage.

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

Obesity is a chronic and progressive disease that affects approximately 107.7 million children and adolescents worldwide and is associated with multiple coexisting conditions and complications. More than 70% of persons who have obesity before puberty will also have obesity as

We are both physician trainees — a cardiology fellow and a general surgery resident — in New York City. We are one of the nearly 10,000 dual-physician couples nationwide who, over the past 30 years, have embarked on the arduous

Tobacco use kills more than 8 million people every year, 1 million of them from second-hand smoke exposure. For World No Tobacco Day on May 31, 2020, WHO is launching a new global anti-tobacco campaign that, for the first time,

The final act of Philip Roth’s achingly poignant novel, Nemesis, based on the 1944 polio epidemic condenses the trajectories of each of the main protagonists’ lives as a result of events that sultry summer, Bucky Cantor, swapping life stories with

To rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series. Massachusetts quickly followed New

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

To the Editor: On February 20, 2020, the incidence of Covid-19 began to rapidly escalate in Italy. By March 25, Italy had the second highest number of Covid-19 infections worldwide and the greatest number of deaths. Children younger than 18

Examination of the optic nerves is a fundamental component of the clinical examination, but direct ophthalmoscopy is usually avoided or poorly performed by general physicians and nonophthalmic specialists. Detection of papilledema, defined as optic-nerve edema from intracranial hypertension, and…

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

The novel coronavirus disease 2019 (COVID-19) has swept across 210 countries and territories with over 1·2 million cases and 67 594 deaths reported by April 6, 2020. Most countries have implemented social distancing measures to curb the spread of infection and

Sepia In the pre-internet era, in the days of non-digital photography, most families owned and treasured their albums of pictures. Often arranged chronologically by year, each series of collections defined lives. Unlike today’s ubiquitous smart phone compilations hung out to

Perinatal care for extremely preterm infants As I write, at the end of March, we are in lockdown. Deaths due to Covid-19 are rising at the rate predicted by epidemiological modelling, and there is enormous tension about whether intensive care

Accurate assessment of the optic-nerve head, the optic disk, by funduscopy is an important, cost-effective, and noninvasive diagnostic tool for a variety of ocular, neurologic, and inflammatory conditions. Unfortunately, reliable funduscopic assessment is challenging for clinicians working with…

Neurofibromatosis type 1, an autosomal dominant genetic disorder characterized by multiple progressive tumor and nontumor manifestations, has limited treatment options. In patients with the disorder, dysfunction of the guanosine triphosphatase–activating protein neurofibromin leads to…

This systematic review and meta-analysis evaluates published data on pubertal timing based on age at thelarche and evaluates the change in pubertal onset in healthy girls around the world.

To the Editor: A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children, and our understanding of the spectrum of illness is limited. We conducted a retrospective analysis involving hospitalized children in Wuhan, China. From

Obesity is a chronic and progressive disease that affects approximately 107.7 million children and adolescents worldwide and is associated with multiple coexisting conditions and complications. More than 70% of persons who have obesity before puberty will also have obesity as

On April 1, 2020, the Trump administration plans to implement the first in a series of three proposed changes to the Supplemental Nutrition Assistance Program (SNAP), the federal safety-net program formerly known as “food stamps.” More than 36 million Americans,

Smoking rates peaked in the United States in the mid 1960s and have since declined to historically low levels. In contrast, use of e-cigarettes has recently soared, particularly among young people. In 2019, more than 27% of high school students

Neurofibromatosis type 1, an autosomal dominant genetic disorder characterized by multiple progressive tumor and nontumor manifestations, has limited treatment options. In patients with the disorder, dysfunction of the guanosine triphosphatase–activating protein neurofibromin leads to…

Unpredictability ‘The world is so unpredictable. Things happen suddenly, unexpectedly… We want to feel we are in control of our own existence. In some ways we are, in some ways we’re not. We are ruled by the forces of chance

On Feb 18, 2020, Quaden Bayles’ mother broadcasted a heart-breaking video live on Facebook, in which the 9-year-old boy cried and said he wanted to end his life because of the relentless bullying about his health condition. Quaden has achondroplasia,

To the Editor: A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children, and our understanding of the spectrum of illness is limited. We conducted a retrospective analysis involving hospitalized children in Wuhan, China. From

On average, Americans have worse health outcomes than their counterparts in other high-income countries, even though the United States spends far more on health care than those countries do. This disparity is often attributed to social factors that influence health,

On April 1, 2020, the Trump administration plans to implement the first in a series of three proposed changes to the Supplemental Nutrition Assistance Program (SNAP), the federal safety-net program formerly known as “food stamps.” More than 36 million Americans,

This case-control study assesses whether an association exists between maternal psychological distress and brain development in fetuses with congenital heart disease among pregnant women carrying fetuses with the disease vs healthy volunteers with low-risk pregnancies recruited from the US Children’s

This past year has demonstrated how dangerous U.S. detention centers have become for migrant children. Before September 2018, no child had died in the care of the U.S. Department of Homeland Security’s Customs and Border Protection (CBP) in a decade.

Presentation of Case. Dr. Max C. Petersen (Medicine): A 34-year-old woman was evaluated in the diabetes clinic of this hospital for hyperglycemia. Eleven years before this presentation, the blood glucose level was 126 mg per deciliter (7.0 mmol per liter)

Heads above parapets Putting one’s head above the parapet is a term synonymous with ‘guts’: risking exposure, opprobrium and exclusion it is particularly germane in the scientific world when the middle of the road approach (‘more research is needed’) is

Sepsis is the body’s extreme response to infection. Paediatric and neonatal sepsis account for more than half of all sepsis cases worldwide, according to the Global Burden of Disease study on sepsis. In 2017, an estimated 20·3 million incident sepsis

Presentation of Case. Dr. Madeline L. Keyes (Pediatrics): A 32-day-old male infant was transferred to the emergency department and admitted to this hospital for evaluation of suspected abusive head trauma. On the evening of admission, the patient’s mother called emergency

The authors of this paper (Arch Dis Child Fetal Neonatal Ed 2019;104:F313–19) were alerted by a reader of the journal to errors in the reporting of their primary outcome for this trial. The errors in the manuscript are as follows:

Milk products from cows and other nonhuman mammals are major components of traditional Western diets, especially in cold climates. The recommended intake of milk or equivalent portions of cheese, yogurt, or other dairy products in the United States is three

Presentation of Case. Dr. Madeline L. Keyes (Pediatrics): A 32-day-old male infant was transferred to the emergency department and admitted to this hospital for evaluation of suspected abusive head trauma. On the evening of admission, the patient’s mother called emergency

Milk products from cows and other nonhuman mammals are major components of traditional Western diets, especially in cold climates. The recommended intake of milk or equivalent portions of cheese, yogurt, or other dairy products in the United States is three

Asthma is a major cause of illness and health care costs: in 2016, almost 200,000 Americans were admitted to the hospital for an asthma attack, and 40% of them were children (https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm). It therefore makes sense to consider asthma prevention

Hypoglycemia is the most common metabolic problem in newborns and may lead to persistent brain injury. Because neonatal hypoglycemia often is asymptomatic, up to 30% of all newborns are routinely monitored for hypoglycemia for 12 to 36 hours after birth

Asthma is a major cause of illness and health care costs: in 2016, almost 200,000 Americans were admitted to the hospital for an asthma attack, and 40% of them were children (https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm). It therefore makes sense to consider asthma prevention

This cross-sectional study examines clinical practice regarding measles-mumps-rubella (MMR) vaccination of pediatric international travelers and assesses reasons for nonvaccination of infants and children identified as eligible for vaccination.

Objective This cross-sectional study set in a single school on the outskirts of a large city aimed to document the extent of double burden of malnutrition (coexistence of overnutrition and undernutrition) among Indian schoolchildren from lower socioeconomic groups, and to

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This past year has demonstrated how dangerous U.S. detention centers have become for migrant children. Before September 2018, no child had died in the care of the U.S. Department of Homeland Security’s Customs and Border Protection (CBP) in a decade.

Meningococcal B disease is a curious and terrifying condition with unusual epidemiology. Sporadic cases occur throughout the world, with occasional small outbreaks, but large-scale epidemics, when they occur, can last for a decade or more. Unlike other meningococcal serogroups, meningococcal

Invasive meningococcal disease, caused by Neisseria meningitidis, is an important cause of disease and death worldwide, owing to difficulties in early diagnosis, a rapid clinical progression, and a high case fatality rate. The most important meningococcal disease–associated capsular groups are

Meningococcal B disease is a curious and terrifying condition with unusual epidemiology. Sporadic cases occur throughout the world, with occasional small outbreaks, but large-scale epidemics, when they occur, can last for a decade or more. Unlike other meningococcal serogroups, meningococcal

Since the turn of the century, antimicrobial resistance has been a mounting threat. Progressing at a faster rate than predicted, drug-resistant strains of Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, tuberculosis, and malaria are now widespread, and resistance in HIV and

Treatment options for congenital heart disease are limited by the relative inability of mature cardiac muscle cells (cardiomyocytes) to generate new cardiomyocytes through proliferation after birth. The current understanding of how human cardiomyocytes proliferate during heart growth is incomplete,…

Wake up calls I’ve been quite unwell over the last few weeks: nothing, in the great scheme of things that would count (other than to my family and me) as ‘major’, but enough to have to postpone a trip to

Advances in the care of infants born before 28 weeks of gestation have been associated with a dramatic improvement in survival. However, one or more major impairments (e.g. cerebral palsy, intellectual disability, deafness, or blindness) develop in approximately 40% of

Treatment options for congenital heart disease are limited by the relative inability of mature cardiac muscle cells (cardiomyocytes) to generate new cardiomyocytes through proliferation after birth. The current understanding of how human cardiomyocytes proliferate during heart growth is incomplete,…

Global challenges to children’s health are rooted in social and environmental determinants. The UN Convention on the Rights of the Child (CRC) articulates the rights required to address these civil-political, social, economic and cultural determinants of child well-being. The principles

Presentation of Case. Dr. Jenna R. Lillemoe (Pediatrics): An 11-year-old boy was seen in the emergency department of this hospital because of ongoing vomiting and weight loss. One month before this presentation, the patient was evaluated by his primary care

This survey study investigates the association of banning electronic cigarette (e-cigarette) sales to minors in Canada with e-cigarette use among youths and the mechanisms through which a ban might be associated with e-cigarette use.

Schistosomiasis is a parasitic neglected tropical disease that is estimated to currently infect more than 140 million persons. Ninety percent of the disease burden is in sub-Saharan Africa, where the main species that cause schistosomiasis in humans are Schistosoma mansoni

Schistosomiasis is an ancient, neglected parasitic disease caused by blood flukes (trematode worms) of the genus schistosoma. Affecting an estimated 200 million persons in 78 countries, the disease is intimately associated with poverty and is grossly debilitating, leading to chronic

Schistosomiasis is a parasitic neglected tropical disease that is estimated to currently infect more than 140 million persons. Ninety percent of the disease burden is in sub-Saharan Africa, where the main species that cause schistosomiasis in humans are Schistosoma mansoni

Schistosomiasis is an ancient, neglected parasitic disease caused by blood flukes (trematode worms) of the genus schistosoma. Affecting an estimated 200 million persons in 78 countries, the disease is intimately associated with poverty and is grossly debilitating, leading to chronic

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage.

It wasn’t until the early 1800s that children’s rights were societally acknowledged with the enactment of laws preventing child labour. The next milestone was the creation by the League of Nations of a committee for the protection of children. Soon

Physiological studies of transition There are two thought provoking physiological studies from the group in Melbourne, Australia, led by Stuart Hooper. Both concern the physiology of transition in relation to whether or not the umbilical cord is clamped. In the

In 1928, Sir Alexander Fleming discovered that the active component of a penicillium fungus had the capacity to kill bacteria in a petri dish, and he named it penicillin. In 1945, Fleming, Florey, and Chain were jointly awarded the Nobel

The 30th anniversary of the UN Convention on the Rights of the Child (UNCRC) on Nov 20, 2019, is a chance to reflect on the global status of children’s rights. A report by UNICEF addresses the progress made in the

Typhoid fever is a systemic illness caused by Salmonella enterica serovar Typhi. An estimated 11 million to 21 million cases of febrile illness and 117,000 to 161,000 deaths are attributed to the disease each year. Typhoid fever is a major

Typhoid fever is caused by fecal–oral transmission of Salmonella enterica serovar Typhi (S. Typhi). It has been a deadly companion to mankind for centuries, affecting 10.9 million persons and resulting in an estimated 116,800 deaths per year. Although vaccines against

To the Editor: The SAM syndrome, which is characterized by severe dermatitis, multiple allergies, and metabolic wasting (Online Mendelian Inheritance in Man number, 615508), is a congenital skin disease caused by mutations in the genes encoding either desmoglein-1 (DSG1) or

This study uses survey data to examine the racial/ethnic disparities in breastfeeding trends in the United States.

Evidence supports the use of benzodiazepines as the initial treatment for status epilepticus; however, seizures do not respond to benzodiazepines in up to a third of patients. The treatment for this type of benzodiazepine-refractory status epilepticus has not been well

Dengue is a pandemic-prone viral disease, the incidence of which has increased by a factor of 30 over the past 50 years. Nearly half of the world’s population lives in dengue-endemic areas in more than 100 countries worldwide, where approximately

Real life: just fantasy? Lest anyone risks seducing themselves to the contrary, we should remind ourselves constantly how little (if anything) we genuinely know. Time gives us more familiarity with exposure outcome phenotype pattern recognition but do we get closer

Acute upper airway obstruction is a life-threatening emergency and requires immediate assessment and intervention with little margin for error, making it a constant challenge for clinicians. Substantial advances have been made in preventive medicine, our understanding of the pathophysiology of…

Cystic fibrosis is a lethal, inherited, autosomal recessive disorder that affects approximately 80,000 people worldwide and is caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein that lead to reduced CFTR function. CFTR codes

Advancing technology has changed the way we communicate and interact with the world around us. For the majority of modern adolescents, social media and online messaging is a core aspect of forming and maintaining friendships. Yet there is concern from

Schizophrenia is a psychiatric syndrome characterized by psychotic symptoms of hallucinations, delusions, and disorganized speech, by negative symptoms such as decreased motivation and diminished expressiveness, and by cognitive deficits involving impaired executive functions, memory, and speed of…

Presentation of Case. Dr. Akash Gupta (Pediatrics): A 16-year-old boy was admitted to this hospital in autumn because of jaundice and abnormal results on liver-function tests. The patient had been well until 4 days before admission, when he noted pruritus

This systematic review and meta-analysis investigates the association between obesity treatment interventions, with a dietary component, and symptoms of depression and anxiety in children and adolescents with overweight/obesity.

Schizophrenia is a psychiatric syndrome characterized by psychotic symptoms of hallucinations, delusions, and disorganized speech, by negative symptoms such as decreased motivation and diminished expressiveness, and by cognitive deficits involving impaired executive functions, memory, and speed of…

Presentation of Case. Dr. Akash Gupta (Pediatrics): A 16-year-old boy was admitted to this hospital in autumn because of jaundice and abnormal results on liver-function tests. The patient had been well until 4 days before admission, when he noted pruritus

Rare diseases in aggregate affect approximately 30 million persons in the United States alone. Although next-generation sequencing is revolutionizing their diagnosis, the sheer number of distinct conditions (more than 7000 [https://globalgenes.org/rare-list]) and the limited number of patients…

Concerns have been raised about the risk of several neurodegenerative diseases, such as Alzheimer’s disease, amyotrophic lateral sclerosis, and chronic traumatic encephalopathy (CTE), associated with participation in contact sports. Recognition of the pathologic changes of CTE in former players who…

In the general population, moderate exercise, physical activity, and participation in sports have important health benefits, including slowing cognitive decline and preventing dementia. Participation in elite-level sports, not surprisingly, is also associated with reductions in all-cause mortality…

Familial hypercholesterolemia is a common autosomal dominant disorder of lipoprotein metabolism. It is caused by mutations in genes encoding key proteins involved in the low-density lipoprotein (LDL) receptor endocytic and recycling pathways that lead to decreased cellular uptake of LDL…

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Pulseless electrical activity Deandra Luong and colleagues report a series of infants where ECG monitoring was used to monitor the heart rate during initial stabilisation after birth and there was no clinically detectable cardiac output despite ECG traces showing heart

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Infants who are very preterm ( Existing trial data are insufficient to determine whether advancing enteral feeding volumes slowly (typically by Methods. Trial Design and Procedures. The trial was a multicenter, parallel-group, randomized, controlled trial that followed a published protocol

To the Editor: The rapid increase in adolescents’ use of electronic cigarettes (known as vaping) during the past decade has aroused public health concern, recently heightened by potential links between vaping and acute lung injury. Adolescents who vape use a

At the UN General Assembly (UNGA) on Sept 23, a high-level meeting on universal health coverage reaffirmed the value of achieving the highest attainable standard of physical and mental health for every human being. Heads of State and Government recommitted

Kim et al. in a report now published in the Journal, describe the discovery, development, and administration of an antisense oligonucleotide (ASO) therapy specifically designed for a single patient with CLN7 neuronal ceroid lipofuscinosis (a form of Batten’s disease), a

This systematic review and meta-analysis of longitudinal and cross-sectional studies examines the association between electronic cigarette use and marijuana use in people aged 10 to 24 years.

Inhaled glucocorticoids are effective first-line therapies for asthma control, but when asthma remains poorly controlled, the recommended treatment is the addition of a long-acting β2-adrenergic receptor agonist (LABA). However, this recommendation is based on studies that included few patients who…

On August 3, 2019, a white supremacist with an AK-47 opened fire on shoppers in an El Paso Walmart, killing 22 people, including a 15-year-old, and wounding scores more, including a 9-year-old and a 2-year-old. Parents and grandparents died protecting

Presentation of Case. Dr. Batul Kaj: A 14-month-old boy was evaluated in the pediatric gastroenterology clinic of this hospital because of vomiting. The patient was born at another hospital to a 35-year-old mother by cesarean section because of arrest of

To the Editor: Much has been written on the potential dangers of sporting activities in children and young adults with potentially arrhythmogenic cardiac conditions. Current international guidelines recommend avoidance of strenuous activity and competitive sports in persons with these conditions.…

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To the Editor: The rapid increase in adolescents’ use of electronic cigarettes (known as vaping) during the past decade has aroused public health concern, recently heightened by potential links between vaping and acute lung injury. Adolescents who vape use a

Presentation of Case. Dr. Bethany L. Bartley (Pediatrics): A 22-year-old woman was seen in the pediatric pulmonary clinic of this hospital because of chest pain, cough, and dyspnea on exertion. The patient had been well until she was 2 months

Those with even a rudimentary knowledge of biomedical progress understand how advances in delineating the components of the immune system have led to new means of manipulating it, including vaccines as well as drugs and biologic agents to ameliorate cancer

Dental caries in childhood is simultaneously a visible and an invisible issue. Children with tooth decay might have noticeable difficulty in eating, speaking, and sleeping, experience distress and pain, and smile less—which in turn affect their development, wellbeing, family and

On August 3, 2019, a white supremacist with an AK-47 opened fire on shoppers in an El Paso Walmart, killing 22 people, including a 15-year-old, and wounding scores more, including a 9-year-old and a 2-year-old. Parents and grandparents died protecting

This cohort study explores the association between nonmedical prescription opioid use and an increased risk of future heroin use initiation among adolescents in Los Angeles, California.

Presentation of Case. Dr. Hung M. Le (Pediatrics): A 16-year-old girl was seen in the sports concussion clinic at this hospital because of headache, dizziness, balance problems, fatigue, irritability, and difficulties with sleep and concentration after she had head trauma

Martin Ward Platt The last week of July has seen some very sad news. Our great friend, senior editor, and inspirational colleague, Martin Ward Platt, has died after a long illness. Martin, who was also interim Editor in Chief in

Martin Ward Platt The last week of July has seen some very sad news. Our great friend, senior editor, and inspirational colleague, Martin Ward Platt, has died after a long illness. Martin, who was also interim Editor in Chief in 2017,

Type 1 diabetes is caused by the autoimmune destruction of insulin-producing beta cells in the islets of Langerhans, which leads to dependence on exogenous insulin for survival. Approximately 1 million to 1.5 million Americans have type 1 diabetes, which is

Sickle cell disease affects approximately 100,000 persons in the United States and reduces life expectancy by approximately 30 years. The disease is caused by a single amino acid substitution resulting in the production of sickle hemoglobin (HbS). HbS polymerizes when

Globally, 700 children are diagnosed with cancer every day. In high-income countries such as the USA, cancer remains the leading cause of death by disease in children younger than 19 years, despite survival rates having dramatically improved recently—80% of these

Yellow fever is a mosquito-borne viral disease endemic to tropical and subtropical regions in Africa and the Americas. Infection with yellow fever virus can result in subclinical to severe illness, characterized by fever, jaundice, and hemorrhage. There were an estimated

This randomized clinical trial assesses whether providing a drug disposal bag along with postoperative discharge instructions on opioid use, storage, and disposal affects the rate of proper opioid disposal compared with that for providing only the discharge instructions among families

Severe anemia (hemoglobin level In the Transfusion and Treatment of Severe Anemia in African Children Trial (TRACT), we compared four interventions. Here, we compare immediate transfusion with no immediate transfusion, in which transfusion was triggered by the development of new

Yellow fever is a mosquito-borne viral disease endemic to tropical and subtropical regions in Africa and the Americas. Infection with yellow fever virus can result in subclinical to severe illness, characterized by fever, jaundice, and hemorrhage. There were an estimated

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage.

Neural-tube defects occur by the end of the sixth week of pregnancy (i.e. the fourth week after fertilization) and have been associated with exposure to specific drugs early in pregnancy. Concerns about neural-tube defects among children exposed to efavirenz at

Case A: London. Twenty-year-old Ms. Z. presented to the emergency department (ED) of a hospital in London, anxious and hyperventilating after 4 days sheltering on night buses. She was brought in by an elderly couple whom she had approached when

Global health: Charges to migrant children’s families In a hard-hitting salvo, Russell and colleagues argue that recent changes to charging regulations in the NHS, both undermine child health and represent a departure from the founding principles of the organisation. The

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The United States has been experiencing an increasing number of measles outbreaks, and more measles cases were reported in the first 5 months of 2019 than in any full year since 1992, which was 8 years before endemic transmission was

The establishment of June 13 as International Albinism Awareness Day by the UN General Assembly “as a response to the appeal by civil society organizations that advocate for individuals with albinism as a specific group with specific needs that require

Achondroplasia is the most common form of disproportionate short stature, with a prevalence of 1 in 25,000 live births. The condition is caused by an autosomal dominant mutation in the fibroblast growth factor receptor 3 gene (FGFR3) that constitutively activates

Heatstroke is the most hazardous condition in a spectrum of illnesses progressing from heat exhaustion to heatstroke, in which a shared finding is hyperthermia (i.e. the rise in core body temperature when heat accumulation overrides heat dissipation during exercise or

To the Editor: The rapid accrual of knowledge in genomic medicine has prompted the reanalysis of existing data. We clinically reanalyzed data from two patient series that had undergone diagnostic proband-only exome sequencing. The exome sequences of the first series

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

Heatstroke is the most hazardous condition in a spectrum of illnesses progressing from heat exhaustion to heatstroke, in which a shared finding is hyperthermia (i.e. the rise in core body temperature when heat accumulation overrides heat dissipation during exercise or

To the Editor: The rapid accrual of knowledge in genomic medicine has prompted the reanalysis of existing data. We clinically reanalyzed data from two patient series that had undergone diagnostic proband-only exome sequencing. The exome sequences of the first series

Global health: tuberculosisDiagnosis Though the WHO endorsed gold standard for diagnosing tuberculosis in all age groups is positive microbiology, this is notoriously difficult to achieve in children. If all else fails and the infrastructure allows, bronchoscopy is an option, but

Automated FiO2 adjustment In an issue bursting with great content the Editor’s choice this month is closed-loop automated FiO2 control. The potential for this technology to improve clinical outcomes of high-risk preterm infants is obvious and most manufacturers are working

The gravity of gender inequality seems to have, at last, reached all sectors of society. A watershed on dangerously permissive attitudes to sexual assaults, outrage at gender-oriented discrimination, and a refusal to accept socially constructed gender roles are aired daily

This analysis of the Global Disease Burden data estimates mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories worldwide.

Global child healthAntibiotics in non-bloody diarrhoea Managing infectious diarrhoea is essentially uncomplicated. In only a small proportion of children, those with bloody diarrhoea (shigella, cholera amoebiasis) and associated toxicity or sepsis are antibiotics indicated. In other situations, they can prolong

While primary school enrolment rate in developing regions reached 91% at the end of the Millennium Development Goal era, 60% of children and adolescents worldwide (617 million) are not achieving basic proficiency in reading and mathematics expected of their school

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

As we continue our plan to make the journal fatter in terms of articles per issue, it becomes increasingly difficult to choose which articles to highlight in Fantoms without leaving out lots of interesting content. Nutrition There is a strong nutritional

Milestones Like many words with an implicit sense of drama, ‘milestones’ has become something of an overused term, a ‘millstone’, if you will. There are occasions, though, where it is fully justified and, by chance, this month’s issue describes events

Vaccine hesitancy, which is defined by WHO as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”, has been reported in more than 90% of countries in the world. In many areas, immunisation for measles, a

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Attention deficit–hyperactivity disorder (ADHD) is one of the most commonly diagnosed conditions in child and adolescent mental health services. Stimulants, including methylphenidate and amphetamines, are recommended for ADHD treatment. Methylphenidate is the most frequently prescribed stimulant in…

In Kipling’s seminal novel ‘Kim’, the central premise (literal and metaphorical) is the wresting for power in fin de (19th) siècle South Asia. This attritional confrontation became popularly known as the Great Game and, though ostensibly a children’s book, is really

Poverty disproportionately affects the young. Worldwide, one in five children—a staggering 385 million—survive on less than US$1·90 per day. Such extreme poverty affects 21% of children aged 0–9 years and 15–19% of adolescents (10–17 years), compared with 10% of adults,

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Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

Measuring growth One might have thought that something as basic as charting the growth of preterm babies might have been a settled issue by now, but as we all know, this is far from the case. We carried an important

Global child healthVitamin A The history of the vitamin A supplementation studies from the initial excitement of the reduction in measles related mortality trials in West Africa 25 years ago has been a chequered one. The routine population supplementation from

Objective Significant haemodynamic changes occur at delivery impacting organ blood flow distribution. We aimed to characterise Doppler indices patterns over time in three different organs (brain, gut and kidney) and test them as measures of vascular resistance. Design Observational cohort

In Australia, in the first month of 2019 alone, five Aboriginal girls, aged 12–15 years, have taken their own lives and a 12-year-old boy is critically ill after attempt suicide. Indigenous children (5–17 years old) in Australia die from suicide

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

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Background and objectives Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine

Objective To establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented. Study design Retrospective review

Pragmatism Pragmatism is generally taken to mean ‘practical’, a means of operation which is both user and subject friendly. We are all bound to an extent by pragmatism as this defines the world we inhabit, simultaneously adhering to certain rules

Since August, 2018, an outbreak of Ebola virus disease has been ongoing in the North Kivu province in the Democratic Republic of the Congo. This is the tenth outbreak of the disease in the country since 1976, but what makes

To the Editor: A rapid increase in the prevalence of vaping among adolescents has aroused public health concern. Adolescents who “vape” use a device such as an electronic cigarette to inhale a heated aerosol, which typically contains nicotine. In 2017,

This multicenter cohort study describes the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex and develops centile curves to inform families about children after concussion recovery.

On June 26, 2018, a federal judge ordered the Trump administration to reunite families that it had separated at the U.S.–Mexico border. As of mid-October, however, an analysis by the American Civil Liberties Union showed that 245 children were still

The arrival of a newborn is a highly anticipated occasion. But for families with preterm and ill babies, the associated health challenges and psychological burden can make the occasion a stressful one. Each year in Europe, an estimated 500 000 babies—roughly

Recipe for success The editor’s choice this month would make a great choice for your journal club. When you have read it and the accompanying editorial by Lamia Soghier and Billie Lou Short you will want plenty of your colleagues

Parsimony Parsimony, ‘the quality of frugality in the use of resources’, is an unusual term. Unusual in that it has both pejorative (personal—meanness) and complimentary connotations. A parsimonious statistical model, for example, makes fewer assumptions, has fewer variables and has

This cohort study assesses whether echocardiographic imaging of pediatric patients with Kawasaki diseaes 6 weeks after onset of illness adds value for patients whose earlier examinations showed no coronary artery abnormalities.

Variable rates of diagnosis and treatment of attention deficit–hyperactivity disorder (ADHD) across the United States have aroused concern about overdiagnosis, underdiagnosis, and appropriate treatment. Over the past two decades, rates of diagnosis and treatment of ADHD have increased. Among…

The prevalence of peanut allergy among children in the United States and other industrialized countries is on the rise. Peanut allergy usually persists into adulthood, is occasionally life-threatening, and accounts for the majority of deaths related to food allergy. Because

Figure 1.

Evolving… I’ve always had a fear (and I accept it might be irrational) of becoming fixed in any set way of thinking, the ‘that’s how it’s done’ stance. Practices from 25 years ago, are now looked at (affectionately) as historical

Children with severe allergies, and their parents, remain in a state of anxiety as an international shortage of life-saving medication continues. EpiPens, the leading brand of epinephrine autoinjectors used to treat anaphylaxis, have been in short supply since November, 2017.

Over the past 20 years, medical professionals and the general public have gained clearer understanding that mild traumatic brain injury (mTBI), or concussion, is often not a benign, self-limited condition as once thought. Rather, it may result in persistent physical,

The hemoglobinopathies, disorders that are caused by mutations in genes that encode the “adult” globins, exert a devastating toll on patients and their families. Worldwide, approximately 300,000 babies are born with sickle cell disease and 60,000 are born with β-thalassemia

Summary The 1960s heralded an era when rapid advances in technology led to tremendous advances in medicine. We describe how the European Society for Paediatric Nephrology (ESPN) marked its 50th anniversary by creating an oral video archive from early pioneers

The UK has a higher mortality for children from birth to 5 years old compared with most other countries in Western Europe,1 and this has been recognised as a national priority by the Royal College of Paediatrics and Child Health.

Twenty-first century parents want to be assured that their newborn infant is ‘normal’. But how reliable is the routine newborn examination procedure? Should parents trust us as health professionals when we say, or imply, that they have a normal, healthy

Sweden lost its World Cup quarter final to England in summer 2018, but it has certainly met its goals for infant survival. Child mortality is almost twice as high in England as Sweden, according to a study by Zylbersztejn et

World Cup winners… Hugo Lagercrantz’s editorial (see page 1005) based on the recent Lancet paper by Zylberszteyn examining relative child mortality in Sweden and England reinforces some home truths. Unsurprisingly, as the largest contributor to the numerator, the greatest difference

Objective To determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants. Study design We systematically searched PubMed, EMBASE and the Cochrane Library. Two reviewers independently selected randomised controlled trials (RCTs) of

Congenital diaphragmatic hernia (CDH) remains one of the most challenging conditions to manage in neonatology and neonatal surgery. Despite significant advances in antenatal detection, antenatal therapy, neonatal intensive care and neonatal surgery, there is a significant mortality rate due to

Twin and higher order multiples have a natural frequency of

Some historical aspects Corticosteroids, in the form of hydrocortisone, were first used in neonatal medicine in the 1970s to try to modify the course of respiratory distress syndrome.1 No clinical benefit was shown but the treatment appeared to be without

Postnatal steroids for bronchopulmonary dysplasia While there are many strategies for reducing the risk of BPD, the place of corticosteroids remains uncertain in spite of its long history. This month we publish a network meta-analysis by Zhang et al which

In The Lancet Child & Adolescent Health, Bernadeta Patro Golab and colleagues1 report a meta-analysis combining data sets from 34 prospective pregnancy and birth cohorts from Europe and North America to examine an important public health question: how do maternal

Physical abuse of children is all too common, but often difficult to detect. Although we as physicians usually trust caretaker histories, with cases of abuse those histories are often partial, minimised, or intended to misdirect clinical evaluations. Thus, we usually

Anxiety disorders are among the most common mental health conditions in childhood, and are ranked by WHO as the sixth-largest contributor to non-fatal health loss globally.1 Early-onset anxiety disorders tend to be chronic and can relapse, and are associated with

Healthy lifestyle behaviours are the primary modifiable risk factors for prevention of chronic disease.1 Recognition of the interdependence between various lifestyle behaviours has grown and investigation of their potentially synergistic benefits has increased.2 In The Lancet Child & Adolescent Health,

Alcohol is one of the most commonly used legal, addictive substances in adolescence. Consumption by peers heavily influences initiation of use, and most young people drink alcohol in social situations to enhance existing friendships and make new ones. Adolescents might

Adolescents’ use of electronic cigarettes initially took the public health community by surprise. In 2011, less than 2% of U.S. high school students reported having used e-cigarettes in the previous month. But by 2015, the percentage had jumped to 16%.

The overall prevalence of childhood obesity remains very high, and the prevalence of very high levels of body-mass index (BMI) for age in children is still rising. Most adolescents who are obese remain so in adulthood. The early onset of

The body-fat content of a healthy full-term infant rises sharply from 10 to 14% at birth to 25 to 30% at 6 months of age, with a consequent 30% increase in the body-mass index (BMI). The accrual of body fat

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage.