The Need for Reproductive Justice in Pediatrics
This Viewpoint discusses the importance of integrating reproductive justice into the clinical practice of pediatricians. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Association of Neighborhood Gun Violence With Mental Health –Related Pediatric Emergency Department Utilization
This cross-sectional study examines the association between neighborhood gun violence and subsequent mental health –related pediatric emergency department utilization. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Preemptive Intervention for Infants Showing Early Signs of Autism
This randomized clinical trial examines whether preemptive intervention compared with usual care reduces the severity of autism symptoms and the odds of an autism spectrum disorder diagnosis among infants showing early signs of autism. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Factors and Challenges in Understanding SARS-CoV-2 RNA Levels, Symptoms, and Transmissibility —Reply
In Reply We appreciate the interest in our study by Kuroda and Toh et al. The goal of our article was to add to the growing knowledge about the association between SARS-CoV-2 viral loads and symptoms in children, one aspect of SARS-CoV-2 transmission. The points raised highlight the complexity of studying the role of children in viral transmission. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Factors and Challenges in Understanding SARS-CoV-2 RNA Levels, Symptoms, and Transmissibility
To the Editor The article by Chung and colleagues reported that SARS-CoV-2 RNA levels as determined by reverse transcription –polymerase chain reaction cycle threshold values were higher in symptomatic participants than in asymptomatic participants among both children and adults. Furthermore, no difference in the SARS-CoV-2 RNA levels was observed between children and adults. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Factors and Challenges in Understanding SARS-CoV-2 RNA Levels, Symptoms, and Transmissibility
To the Editor We read with interest the article by Chung et al. In a cross-sectional analysis of self-collected nasal swabs from King County, Washington, they found a difference in SARS-CoV-2 viral load between symptomatic and asymptomatic individuals but no difference by age within the symptomatic and asymptomatic groups. These findings are important in understanding the risk of transmission in households and in the community —particularly for children, who often present with mild or no symptoms. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Firearm Injuries ’ Impact on US Children
Two thousand six hundred twenty-nine. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 20, 2021 Category: Pediatrics Source Type: research

Increasing Criminalization of Gender-Affirming Care for Transgender Youths
This Viewpoint discusses escalating and organized efforts throughout the United States to curtail gender-affirming care for transgender adolescents. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Correlation Between NIH Funding for Pediatric Research and Pediatric Disease Burden in the US
This cross-sectional analysis evaluates the correlation between National Institutes of Health funding and disease burden across pediatric conditions in the US. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Further Considerations on the Association Between Flavored Tobacco Legislation and High School Student Smoking Rates —Reply
In Reply: I thank my colleagues for their comments on my recent Research Letter. Given space constraints, I will focus on their 3 main critiques. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Further Considerations on the Association Between Flavored Tobacco Legislation and High School Student Smoking Rates
To the Editor I read with interest the difference-in-differences analysis of youth smoking and a ban on sales of flavored tobacco products in San Francisco, California, by Friedman. While I believe the article presents a hypothesis worthy of scientific study, there are 2 main reasons I believe the conclusions drawn from this study should be tempered. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Further Considerations on the Association Between Flavored Tobacco Legislation and High School Student Smoking Rates
To the Editor We read with great interest the article by Friedman The author found that a local ban of characterizing flavors in tobacco products was associated with an increase in combustible cigarette smoking from 2017 to 2019 in San Francisco, California. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Further Considerations on the Association Between Flavored Tobacco Legislation and High School Student Smoking Rates
To the Editor We believe the study by Friedman about the association between flavored tobacco product legislation in San Francisco, California, and high school student smoking rates arrived at a premature conclusion. The study was based primarily on a single data point of the smoking rate in 2019 and did not discuss several confounding factors. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the ED
This cross-sectional study explores the use of physical restraint on youth at risk of harming themselves or others in the emergency department, stratified by race and ethnicity. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

How Can the Pediatric Community Enhance Funding for Child Health Research?
Children (younger than 18 years) in the US represent 22% of the total population. Although this segment of the population is healthier than older populations, the prevalence of children with complex medical conditions is growing rapidly, now constitutes an estimated 3% to 5% of the total childhood population, and represents a growing contribution to the numbers of children hospitalized on a daily basis in the US. In addition, it is increasingly clear that many of the antecedents of adult chronic disease, including mental disorders and obesity and cardiovascular disorders, reside in the first 18 years of life, often before ...
Source: JAMA Pediatrics - September 13, 2021 Category: Pediatrics Source Type: research

Early-Onset Kidney Stone Disease —Consequences and Opportunities
This Viewpoint discusses the increasing incidence of early-onset kidney stone disease, its epidemiology and consequences, and the need for more data to inform treatment decisions. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

Police Exposures and the Health and Well-being of Black Youth in the US
This systematic review evaluates the literature describing the association between police exposure and health outcomes for Black youth 26 years and younger. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

Effect of Screen Time on Recovery From Concussion
This randomized clinical trial examines whether engaging in vs abstaining from screen time within the first 48 hours after concussion has an effect on the duration of concussive symptoms among patients aged 12 to 25 years. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

Racism, Diminished Returns of Socioeconomic Resources, and Black Middle-Income Children ’s Health Paradox—Reply
In Reply We appreciate the comments made by Assari and Caldwell in response to our Research Letter. We agree that the phenomenon of marginalization-related diminished returns (MDRs) provides a useful framework for contextualizing our findings. For instance, the Figure shows the odds of perceived racism among Black children compared with White children by household income. Black children with a household income of $75  000 or more had higher odds of perceived racism than those with a household income of less than $75 000 (adjusted odds ratio, 8.23; 95% CI, 5.18-13.08 vs 2.43; 95% CI, 1.62-3.67)—an observation that...
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

Racism, Diminished Returns of Socioeconomic Resources, and Black Middle-Income Children ’s Health Paradox
To the Editor In their article, Nagata and colleagues used adolescent brain cognitive development (ABCD) data to show that high income, as a proxy of socioeconomic status (SES), was associated with higher rather than lower perceived racial discrimination (PRD) in Black children aged 10 to 11 years, a pattern that was absent for other racial and ethnic groups. The weaker protective association between SES and exposure to adversity and poor health outcomes for Black families compared with White families is a well-described phenomenon sometimes referred to as marginalization-related diminished returns (MDRs). To date, there h...
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

Injuries to Children and Adolescents by Law Enforcement
This observational study evaluates the demographic and temporal distributions of hospital-treated injuries perpetrated by law enforcement among youth at the intersection of age, sex, and race and ethnicity (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

The Harmful Effects of Policing —From the Neighborhood to the Hospital
From historical slave patrols and the enforcement of Black Codes and Jim Crow laws to the more recent War on Drugs and “stop and frisk,” police violence is one of the oldest forms of structural racism in the US. Policing tactics have relied heavily on the use of force to subjugate Black and Hispanic and Latinx communities and uphold white supremacy by enforcing race, class, and other visible and invisible bounda ries.To maintain these boundaries, police officers are trained to use strategies that include violence and harm, forcing their subjects to acquiesce. While not a new phenomenon, police violence among ra...
Source: JAMA Pediatrics - September 7, 2021 Category: Pediatrics Source Type: research

A Definitive Answer to the Effect of Screen Time on Concussion Recovery
The issue of screen time in concussion management has been debated for more than 2 decades, camouflaged in guidelines regarding cognitive rest and lacking specifics regarding the extent to which screen time should be limited and the duration of these limitations. The most common guidelines for concussion management published by the Concussion in Sport Group in 2017 do not mention the word screen and acknowledge the lack of evidence for any form of cognitive rest, stating, “The basis for recommending physical and cognitive rest is that rest may ease discomfort during the acute recovery period by mitigating post-concus...
Source: JAMA Pediatrics - September 7, 2021 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 - September 1, 2021 Category: Pediatrics Source Type: research

Additional Insights Into the Use of Preterm Formula Among Neonates —Reply
In Reply We thank Alshaikh et al and Mukhopadhyay for their thoughtful comments on our study. We would like to reply to each of their concerns as follows: (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 30, 2021 Category: Pediatrics Source Type: research

Additional Insights Into the Use of Preterm Formula Among Neonates
To the Editor I congratulate Chinnappan et al for the well-designed study on using preterm formula as a replacement for commercial fortifier to enhance growth in preterm neonates in health care settings with limited resources. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 30, 2021 Category: Pediatrics Source Type: research

Additional Insights Into the Use of Preterm Formula Among Neonates
To the Editor We read with great interest the study by Chinnappan et al on the fortification of breast milk with preterm formula powder vs human milk fortifier in preterm infants. This trial addressed the pertinent clinical dilemma regarding optimal fortifier composition for preterm infants, particularly in low- and middle-income countries. The authors reported comparable weight gain and fewer episodes of feed intolerance in preterm infants who received preterm formula powder compared with those who received human milk fortifier. We would like to highlight a few issues and request clarification. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 30, 2021 Category: Pediatrics Source Type: research

One-Year Outcomes of Critical Care Patients Post –COVID-19 Multisystem Inflammatory Syndrome in Children
This study examines 1-year outcomes of critical care patients in the UK after COVID-19 multisystem inflammatory syndrome in children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 30, 2021 Category: Pediatrics Source Type: research

What Parents Need to Know About Childhood Oral Health
This Patient Page describes what childhood caries are and how to prevent them. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 30, 2021 Category: Pediatrics Source Type: research

The Silent Crisis of Pediatric Clinical Practice Guidelines
This Viewpoint discusses how to improve the current state of Clinical Practice Guidelines. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

Psychosocial Effect of Newborn Genomic Sequencing on Families in the BabySeq Project
This randomized clinical trial assesses the psychosocial effect of newborn genomic sequencing on families of newborns in the BabySeq Project. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

Validation of the Association of Oral Corticosteroid Bursts With Adverse Events in Children —Reply
In Reply We thank Lin and Wei for their interest in our article. Our study provided real-world evidence of an association between oral corticosteroid bursts (defined as oral corticosteroid use for 14 days or less) and gastrointestinal bleeding, sepsis, and pneumonia. We suggested that when prescribing oral corticosteroids, clinicians consider these potential adverse events. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

Validation of the Association of Oral Corticosteroid Bursts With Adverse Events in Children
To the Editor We read with interest the article by Yao et al, which reported an association between oral corticosteroid bursts and increased risk of gastrointestinal bleeding, sepsis, and pneumonia in children. We would like to discuss some potential issues that were not addressed in this study. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

Medical Uninsurance and Underinsurance Among US Children
This cross-sectional study uses data from the 2016 to 2019 National Survey of Children ’s Health to examine trends in both medical uninsurnace and underinsurance among US children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

The Effect of BabySeq on Pediatric and Genomic Research
In this issue of JAMA Pediatrics, Pereira et al report on a sizable group of healthy newborns screened with whole-exome sequencing (WES) shortly after birth whose world —and the world of their parents—did not end in psychological and emotional Armageddon (so far). Does this mean that we are ready to offer WES to each of the 4 million infants born annually in the US? No. Does it mean that we have made a critical first step in understanding the potential benefits and harms of screening newborns with WES? Absolutely. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 23, 2021 Category: Pediatrics Source Type: research

Collaborative Public Health Strategies to Combat e-Cigarette Regulation Loopholes
This Viewpoint summarizes recent efforts by the states and the US Food and Drug Administration to address the youth e-cigarette epidemic and propose a framework for further efforts. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection
This cohort study determines whether there are differences in the odds of household transmission of COVID-19 by younger children compared with older children. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Further Observations on Pregnancy Complications and COVID-19 Infection —Reply
In Reply Messinger and colleagues argue that the associations we reported between COVID-19 infection in pregnancy and adverse maternal and newborn outcomes may be exaggerated because negative test results were not required for the nondiagnosed group whereas positive test results were required in the asymptomatic diagnosed group. Moreover, they believe asymptomatic women with positive test results were more likely to be tested because they had more risk factors. Such bias is unlikely in our study for the following reasons. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Further Observations on Pregnancy Complications and COVID-19 Infection
To the Editor We read with interest the article by Villar and colleagues and wish to comment on the potential association between COVID-19 infection and higher rates of preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome. SARS-CoV-2 infection induces a state of renin-angiotensin system hyperactivity with elevated levels of angiotensin II (Ang II), interleukin 6 (IL-6), and plasminogen activator inhibitor 1. This proinflammatory state can potentially lead to acute respiratory distress syndrome, cytokine storm, and autoimmunity. Elevated Ang II levels in COVID-19 have been reported...
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Further Observations on Pregnancy Complications and COVID-19 Infection
To the Editor Studies have assessed the risk of adverse outcomes in pregnant women with COVID-19 infection compared with either pregnant women without COVID-19 infection, as in Villar et al, or women with COVID-19 infection who were not pregnant. Finding an appropriate reference group is a challenge for both study types. In Villar et al, COVID-19 diagnosis was defined as laboratory confirmation of infection or the presence of symptoms. The reference group was pregnant women without a COVID-19 diagnosis; a negative test result was not required because most countries did not perform universal testing in pregnancy. As the aut...
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Recreational Cannabis Dispensaries ’ Compliance and Underage Access and Marketing Restrictions
This cross-sectional study examines the compliance of recreational cannabis dispensaries with underage access and exposure to products and marketing in California. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Children as Transmitters of COVID
The iconic article “Cuddlers, Touchers, and Sitters” (formerly entitled “Modes of Transmission of Respiratory Syncytial Virus”) by Hall and Douglas stands to this day as one of the simplest recitations of the behavior of respiratory viruses and children. With an elegant and simple study design, Hall and Dougla s vividly demonstrated that it’s the interactions between susceptible and infected persons that drive much of viral transmission. For those who do not recall this study, Hall and Douglas examined the likelihood of transmission from an infant infected with respiratory syncytial virus (RSV...
Source: JAMA Pediatrics - August 16, 2021 Category: Pediatrics Source Type: research

Parent-Based Sexual Health Promotion and STI Prevention for Youth
This Viewpoint discusses recommendations to leverage parents for sexual health promotion and sexually transmitted infections prevention among adolescents and young adults. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19
This meta-analysis examines the global prevalence of clinically elevated symptoms of depression and anxiety in youth during the first year of the COVID-19 pandemic. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

Effects on Growth of Smell and Taste of Milk During Tube Feeding of Preterm Infants
This randomized clinical trial evaluates the association between regular exposure to the smell and taste of milk during tube feedings and growth in preterm infants. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

A Trial of Albuterol Should Still be Considered for Children with Severe Bronchiolitis —Reply
In Reply We read with interest Horvat and Pelletier ’s commentary and thank them for their interest in our trial, which deimplemented non–evidence-based treatment of infants with bronchiolitis, particularly albuterol use in intervention hospitals. The authors disagreed that compliance with deimplementing non–evidence-based pharmacotherapies sho uld be 100%, advocating for trials of albuterol in children with severe bronchiolitis. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

A Trial of Albuterol Should Still Be Considered for Children With Severe Bronchiolitis
To the Editor The cluster randomized clinical trial by Haskell et al aimed to improve bronchiolitis management by deimplementing potentially unnecessary care, including the use of albuterol. Among the trial ’s findings was a significant increase in the proportion of children who did not receive albuterol (86% in the control group vs 94% in the intervention group). The authors state that “compliance with not using the pharmacotherapies should be 100%.” We disagree. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

Association of 1 Vaping Session With Cellular Oxidative Stress in Otherwise Healthy Young People With No History of Smoking or Vaping
This randomized clinical crossover trial evaluates the association of a single session of electronic cigarette vaping with cellular oxidative stress in healthy young people who do not smoke compared with individuals with long-term tobacco cigarette or electronic cigarette use. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

Addressing the Global Crisis of Child and Adolescent Mental Health
Over the course of the past year of the global COVID-19 pandemic, growing attention has focused on the mental health and well-being of children and adolescents. The study by Racine and colleagues calls attention to a critical need that must be addressed to respond to the global mental health effects of COVID-19 on the world ’s children and adolescents. This meta-analysis consisting of 29 studies totaling 80 879 youth globally found prevalence estimates of clinically significant depression and anxiety symptoms to be significantly higher than the estimates reported prior to the onset of COVID-19 and subsequent lockdo...
Source: JAMA Pediatrics - August 9, 2021 Category: Pediatrics Source Type: research

Setting Priorities to Address Research Gaps in Long-term COVID-19 Outcomes in Children
This Viewpoint describes gaps in research on long-term COVID-19 outcomes in children and provides recommendations to address these gaps. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - August 2, 2021 Category: Pediatrics Source Type: research