Error in Figure
The study titled “Trends in Foster Care Entry Among Children Removed From Their Homes Because of Parental Drug Use, 2000 to 2017,” published online July 15, 2019, had 2 labels switched in the Figure. The label “Entries owing to parental drug use” was positioned over the line that indicated the proportion of foster care entries owing to parental drug use, and the label “Proportion of entries owing to parental drug use” was positioned over the line indicating the total number of foster care entries owing to parental drug use. The labels have been moved to the correct positions. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Is Fluoride Potentially Neurotoxic?
Environmental epidemiology is a field replete with controversies, but the intensity of the debate inspired by the fluoridation of municipal water supplies to reduce dental caries is perhaps unrivaled. Governments, as well as individuals, differ in their assessments of water fluoridation as public policy. The US Centers for Disease Control and Prevention consider water fluoridation to be one of the top 10 public health achievements in the 20th century, reducing both overall caries prevalence and socioeconomic disparities. Regions in which water fluoridation is rare, such as Europe, rely on more targeted strategies to delive...
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Mental Health Screening as the Standard of Care in Pediatric Inflammatory Bowel Disease
Butwicka and colleagues have published a fascinating, landmark cohort study in this issue of JAMA Pediatrics assessing the prevalence of psychiatric diagnoses and symptoms among children with inflammatory bowel disease (IBD) in Sweden. The authors used a rigorous design that compared a cohort of more than 6000 pediatric patients with IBD with hundreds of thousands of healthy controls, as well as a separate cohort comprising the patients ’ own siblings who did not have IBD. Butwicka et al computed hazard ratios for any psychiatric disorder, as well as for multiple specific disorders, and found a hazard ratio of 1.6 fo...
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Decision to Publish Study on Maternal Fluoride Exposure During Pregnancy
This study is neither the first, nor will it be the last, to test the association between prenatal fluoride exposure and cognitive development. We hope that purveyors and consumers of these findings are mindful of that as the implications of this study are debated in the public arena. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Identification of Children With High-Intensity Neurological Impairment
This cross-sectional study describes and evaluates the effectiveness of a refined coding system for distinguishing children with high-intensity neurological impairment from those with lower-intensity neurological conditions. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Clinical Prediction Rule to Identify Febrile Young Infants at Low Risk for Serious Bacterial Infections
To the Editor The treatment of febrile illness among young infants poses a substantial challenge owing to fatal complications derived from serious bacterial infections (SBI). The development of algorithms can provide a means of transferring expert knowledge to the novice to limit unnecessary interventions. The algorithm proposed by Kuppermann et al is simple and yields high negative predictive value (99.6%) in identifying infants with SBIs based on 3 variables: urinalysis, neutrophil count, and procalcitonin. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Efficacy of a Clinical Prediction Rule to Identify Febrile Young Infants at Low Risk for Serious Bacterial Infections
To the Editor I read with interest the article by Kuppermann et al. Results showed that a combination of complete blood count (CBC) absolute neutrophil count less than 4090/mm3 (to convert to ×109 per liter, multiply by 0.001), normal urinalysis results, and procalcitonin (PCT) concentration less than 1.71 ng/mL gave a 99.8% negative predictive value for serious bacterial infections (SBI). (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Clinical Prediction Rule to Identify Febrile Young Infants at Low Risk for Serious Bacterial Infections
To the Editor Fever among infants in the first months of life remains one of the most commonly encountered clinical problems in all pediatric health care. Although most are viral illnesses, approximately 10% are potentially life-threatening serious bacterial infections (SBIs). Risk stratification criteria developed nearly 30 years ago provide conflicting recommendations and predate the availability of newer diagnostic tests with improved ability to discriminate high-risk infants. The most widely used risk stratification strategy, the Rochester criteria, was derived from just 233 infants in 1985. Statistical methods unavail...
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Clinical Prediction Rule to Identify Febrile Young Infants at Low Risk for Serious Bacterial Infections —Reply
In Reply We thank Burstein and Papenburg, Verd and Moll, and Bonadio for the letters pertaining to our study in which we derived and validated a prediction rule for identifying febrile infants 60 days and younger with serious bacterial infections (SBI). Burstein and Papenburg question the use of the less widely available procalcitonin (PCT) rather than the C-reactive protein. They also suggest considering results of viral multiplex testing in the prediction rule. We chose PCT because of its superiority as a screening biomarker compared with C-reactive protein for invasive bacterial infections (bacteremia and/or bacterial m...
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Association Between Maternal Fluoride Exposure During Fetal Development and IQ Scores in Offspring in Canada
This study examines the association between fluoride exposure during pregnancy and IQ scores in a prospective birth cohort. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt
This population-based cohort study examines the risk of psychiatric morbidity among individuals with childhood-onset inflammatory bowel disease, controlling for potential confounding shared between siblings. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Does It Ever Go Away?
This essay describes a difficult conversation between a physician and her son on his diagnosis of diabetes. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 19, 2019 Category: Pediatrics Source Type: research

Parental Tobacco Counseling in the Well-Child Visit —A Method With Enhanced Effectiveness but Nowhere to Go
Exposure to tobacco is the leading preventable cause of disease and death in the United States and as such was noted in the recent US Surgeon General ’s report, “The Health Consequences of Smoking: 50 Years of Progress”: “The epidemic of smoking-caused disease in the 20th century ranks among the greatest public health catastrophes of the century, while the decline of smoking consequent to tobacco control is surely one of public health’s greatest successes.”(p33) As the documented consequences of passive tobacco exposure make clear, these observations are as relevant for the pediatric pop...
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Cost of Pediatric Severe Sepsis Hospitalizations
This study examines the increasing costs of pediatric hospitalizations for cases of severe sepsis using the 2016 Nationwide Readmissions Database. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Negligible Effects on Tumor Risk Associated With In Vitro Fertilization
To the Editor In their study, Spector et al reported a 28% increase in the embryonal tumors rate in children conceived by in vitro fertilization (IVF) compared with children naturally conceived. Most of this risk increase was owing to hepatic tumors, predominantly hepatoblastoma. The authors hypothesized that part of the risk excess observed could be attributable to the association between IVF and epigenetic disruption leading to Beckwith-Wiedemann syndrome (BWS), an epigenetic disorder with embryonal tumor predisposition known to be the most relevant risk factor for hepatoblastoma. Here, we provide an estimate of the magn...
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Association of Cereal, Gluten, and Dietary Fiber Intake With Islet Autoimmunity and Type 1 Diabetes
This cohort study of Finnish children with an increased genetic risk for type 1 diabetes examines the association of the energy-adjusted intake of oats, wheat, rye, gluten-containing cereals, gluten, and dietary fiber with the risk of developing islet autoimmunity. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Association Between Electronic Cigarette Use and Marijuana Use Among Adolescents and Young Adults
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. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Treating Parents for Tobacco Use in the Pediatric Setting
This cluster randomized clinical trial examines the rate at which a tobacco use cessation program implemented in pediatric offices convinces parents who currently smoke to quit. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

The Role of Equity in US States ’ Breastfeeding Policies
This Viewpoint reviews state-level policies on breastfeeding, with particular attention to finding out if any policies include means to maintain or increase equity across racial/ethnic or socioeconomic groups. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 12, 2019 Category: Pediatrics Source Type: research

Recurrent Febrile Urinary Tract Infections and Renal Scarring
In this issue of JAMA Pediatrics, Shaikh et al continue to shed light on important aspects of urinary tract infections (UTIs) in children based on data gleaned from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) and Careful Urinary Tract Infection Evaluation (CUTIE) trials. The study by Shaikh et al addresses the likelihood of new renal scars developing after a first febrile UTI and after recurrent UTIs. Three decades ago, the pioneering group in Sweden identified a slight increase in renal scarring from the first UTI to the second and from the second to the third; only after 3 UTIs did the rat...
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Changes in Prevalence of Marijuana Consumption Modes Among Colorado High School Students
This study examines data from the Health Kids Colorado Survey to assess changes in modes of marijuana consumption among high school students in Colorado from 2015 to 2017. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Improving the Assessment of Screen Exposure in Children
To the Editor We read with great interest the work presented by Chen et al in their assessment of screen exposure in young children. In an era of increasing technological dependence, we must reflect on the potential consequences of such an environment on a child ’s physical and psychological development. However, we would like to draw attention to some of the limitations that we have found in this study. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Improving the Assessment of Screen Exposure in Children —Reply
In Reply We thank Chen et al for their comments about improving the assessment of screen exposure in children. Our original study, published as a Research Letter, highlights the finding that young children spent most of their screen time watching television, even as mobile devices became increasingly prevalent between 1997 and 2014. The conclusions spur a variety of questions regarding children ’s screen use in the digital age, including those raised by Chen et al, that were beyond the scope of our brief article. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Prevalence and Trends of Overweight and Obesity in European Children
This meta-analysis assessed prevalence and trends in measured overweight and obesity among children across Europe from 1999 to 2016. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Association of Renal Scarring With Number of Febrile Urinary Tract Infections in Children
This post hoc analysis of data from 2 studies examines the association between the number of febrile urinary tract infections and the risk of renal scarring in children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Vitamin D and Enamel Defects
This secondary analysis of a randomized clinical trial assesses the association of a high-dose vitamin D supplementation in pregnant women with enamel defects and caries in their offspring. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Walking on Eggshells With Trainees in the Clinical Learning Environment
This Viewpoint explores communication strategies through which medical faculty and trainees can approach sensitive topics and challenging conversations. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 5, 2019 Category: Pediatrics Source Type: research

Typographical Error in Table 2
This article was corrected online. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

Error in Figure
In the Original Investigation titled “Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada,” published online June 3, 2019, an element of Figure 3F was incorrect. The y-axis of the graph, which shows percentages of patients receiving head magnetic resonance imaging, was mislabeled 0 , 10, 20, 30, and 40; it should have been labeled 0, 1, 2, 3, 4, 5, and 6. The Figure has been corrected online. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

Incorrect Vancomycin Trough Concentrations in Results
This article was corrected online. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

Error in Byline
This article was correct ed online. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

August 2019 Issue Highlights
(Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

JAMA Pediatrics
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. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

Effect of Early Limited Formula and Breastfeeding Duration in the First Year
This randomized clinical trial assigns mother-newborn dyads to exclusive breastfeeding or breastfeeding supplemented with small amounts formula in the first week of life to evaluate the effect of formula supplementation on duration of breastfeeding at 6 and 12 months. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

The Pediatric Clinic Team
This Patient Page describes the members of the pediatric team and how they will interact with parents and children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Parent-Based Interventions to Affect Adolescent Sexual and Reproductive Health
In a recent report, the National Academies of Science, Engineering, and Medicine highlighted adolescence as a critical developmental period for shaping long-term health and well-being. Particularly, adolescent and young adult (AYA) sexual and reproductive health (SRH) remains a national public health priority. The recently reinforced federal initiatives to address HIV, sexually transmitted infections (STIs), and unplanned pregnancies represent a substantial opportunity to eliminate persistent SRH disparities among AYAs in the United States. Each year since 2010, AYAs ages 13 to 24 years have been estimated to account for m...
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Cough and Cold Medicine Recommendations for US Children
This study analyzes trends in physicians ’ recommendations for cough and cold medicine for children in the United States between 2002 and 2015. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Evaluating Screen Time and Child Development
To the Editor On January 28, 2019, the Madigan et al study was published in which they “support the directional association between screen time and child development.” The article received considerable public attention, but its conclusion is problematic. First, all between-person associations were not significant, and the within-person cross-lagged associations were negligible (β , −0.08 and −0.06). Conventional estimates of effect size (eg, Cohen d, R2) were not provided, but assuming that the variables were standardized, the β coefficients equal Pearson r. De facto, the effect sizes, whi...
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Challenging the Association Between Screen Time and Cognitive Development
To the Editor We read with interest the article by Madigan et al, which demonstrated an association between more screen time and subsequent lower performance on developmental screening tests. We noted a substantial drop in screen time between ages 36 months and 60 months (from 24.9 to 10.8 hours) and speculated whether it was perhaps as a result of increase in social play, including play with siblings. Children lacking older siblings would miss out on this social learning opportunity and might also have more screen time. We would be most interested to know whether association between higher screen time at 36 months and low...
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Challenging the Association Between Screen Time and Cognitive Development —Reply
In Reply We appreciate the opportunity to engage in scholarly discussion surrounding our contribution to JAMA Pediatrics on screen time and children ’s development. Ophir et al state that “all between-person associations were not significant.” This is incorrect because the confidence interval for the between-person association does not include zero. They also cite that the “within-person cross-lags were negligible.” We agree that these effect sizes, while significant, are small in magnitude. This is not surprising when one considers that the random-intercepts cross-lag panel model conservative...
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Assessment of Parent-Based Interventions for Adolescent Sexual Health
This systematic review and meta-analysis of 31 studies reporting on 12  464 US adolescents assesses the association of parent-based interventions with adolescent sexual health. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Unbounded —Parent-Physician Communication in the Era of Portal Messaging
This Viewpoint describes the opportunities and challenges created by portal messaging for patients and physicians. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 29, 2019 Category: Pediatrics Source Type: research

Male Pubertal Timing —Boys Will Be Men, but When?
Puberty represents the complex transition from childhood to adulthood characterized by linear growth acceleration and sex hormone –mediated physical changes followed by reproductive capability and skeletal maturity. The timing varies widely and is affected by genetic and environmental factors. Age at sexual maturity in females has progressively declined during the past 2 centuries, with an earlier age of pubertal onset and m enarche in females being driven in part by increased adiposity. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

JAMA Pediatrics Call for Papers on Election-Year Policies and Children's Health
Politicians have been known to kiss babies on the campaign trail, and the faces of children in the news often drum up political fervor. However, children do not vote, and the potential consequences of policies for children ’s health are not always foremost in the minds of candidates or voters during an election cycle. Because children are seen as generally healthy and not the primary drivers of rising health care costs, they are often forgotten in health policy research and debate. Moreover, state and federal spendi ng on health and social welfare demonstrates intergenerational inequities favoring elderly individuals...
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Association of Sleep Problems and Melatonin Use in School-aged Children
This cross-sectional study examines subjectively and objectively assessed sleep and melatonin use in children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Medical Overuse and Appendicitis Treatment
To the Editor We found the 2018 “Update on Pediatric Medical Overuse: A Review” by Coon et al to be a well-meaning attempt at a worthwhile goal. However, we are compelled to comment on the mischaracterization of nonoperative, antibiotic treatment of uncomplicated appendicitis. While many of the topics addressed in the review h ighlight opportunities for resource-effective management in treatment situations for which there is documented clinical equipoise, this is not the case as suggested for acute appendicitis. Citing a meta-analysis in JAMA Pediatrics, Coon et al highlight a claim of 91% success rate of nonop...
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Medical Overuse and Appendicitis Treatment —Reply
In Reply We appreciate Goldstein and Raval ’s letter to the editor regarding our review of the pediatric overuse literature and the opportunity to further consider the benefits and harms of nonoperative treatment of acute uncomplicated appendicitis. The principal advantage of the nonoperative (antibiotic) approach is that it avoids the ris ks associated with anesthesia and surgery. While these risks are low in the hands of pediatric surgeons using a laparoscopic technique for appendectomy, the risk is not zero, and surgical complications are higher in centers without access to pediatric and laparoscopic expertise. Th...
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Effect of a Health Worker –Delivered Intervention on Anemia Cure Rates in Rural Indian Children
This randomized clinical trial evaluates the effects of community-based parental education/counseling when combined with usual treatment on children ’s anemia cure rate in rural southern India. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Secular Trends in Pubertal Growth Acceleration in Swedish Boys Born From 1947 to 1996
This cohort study examines secular trends for earlier pubertal timing in Swedish boys born from 1947 to 1996 using age at peak height velocity as objective assessment of pubertal timing. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 22, 2019 Category: Pediatrics Source Type: research

Coding Error in Analysis of Rotavirus Vaccination and Type 1 Diabetes
This article was corrected online. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - July 15, 2019 Category: Pediatrics Source Type: research