Pediatrics Current

This survey study evaluated whether concerns about parental access to online health information through patient portals altered the amount of sensitive health information by young adults and the likelihood of opening a portal account.

This systemic review and meta-analysis investigates whether cannabis use during adolescence and young adulthood is associated with academic performance.

This randomized clinical trial examines data for children from predominantly low-income households to investigate whether providing free access to an existing community day camp can mitigate accelerated gain in body mass index z score during the summer.

This cross-sectional, ecological study examines US state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race.

This survey study examines rates of satisfaction, regret, and continuity of care in adolescents who received puberty blockers and/or gender-affirming hormones as part of gender-affirming medical care.

This study aims to determine the relationship between the COI and other neighborhood-level indexes that are commonly used in pediatric studies.

This cohort study examines how harsh and warm parenting during early, middle, and late childhood are associated with brain architecture during adolescence and, in turn, psychiatric symptoms in early adulthood during the COVID-19 pandemic.

This randomized clinical trial investigates if the participation of community health workers in an intervention to connect home, school, the health care system, and community for underserved school-aged children with asthma and their caregivers improves asthma control.

In Reply We thank Bhurawala for their comments regarding heterogeneity in the Network Meta-Analysis of Trials of Initial Oxygen in Preterm Newborns (NETMOTION) study. Their letter highlights the importance of examining potential sources of heterogeneity when considering the clinical implications of the finding that high initial fractional inspired oxygen (FiO2) may reduce mortality in preterm infants compared to low or intermediate levels.

This study prospectively investigates the association of prenatal cannabis exposure with executive function and aggressive behavior at age 5 years.

To the Editor I am writing in response to the article by Sotiropoulos et al. The authors present a compelling analysis indicating that high initial fraction of inspired oxygen (FiO2; ≥0.90) may reduce mortality in preterm infants compared to low (≤0.3) or intermediate (0.5-0.65) FiO2.

Cannabis use during pregnancy is increasingly common. In this issue, Keim and colleagues find that prenatal cannabis exposure (PCE) is associated with objectively measured deficits in the executive functions of attention and inhibitory control and with increased observed aggression at age 5 years. PCE was not significantly associated with overall global cognitive ability or other objective measures of executive function and was not associated with any caregiver report of cognition or behavior. The study was conducted between 2016 and 2020 and included 250 mother-child dyads with most study participants living in poverty. The study’s multiple strengths, such as the prospective assessment of cannabis use, objective measurement of child outcomes by standardized testing conducted by blinded assessors to cannabis exposure, and inclusion of multiple confounders, all bolster confidence in the findings.

This JAMA Pediatrics Patient Page describes what parents should know about crying in infants.

This study investigates the association between day care attendance and risk of type 1 diabetes and includes all available literature up to March 10, 2024.

This cohort study examines the associations of zip code–level right-to-counsel access with risk of adverse birth outcomes, including preterm birth and low birth weight, among infants born to Medicaid-insured birthing parents in New York, New York.

In Reply We appreciate the letter from Triunfo and Boselli and applaud their efforts to promote COVID-19 vaccination in pregnant people in Italy. We agree with Triunfo and Boselli that our study from the Vaccine Safety Datalink showing no association between first trimester vaccination and major structural birth defects among 42 156 live births, including 7632 with first trimester mRNA COVID-19 vaccination, is reassuring. Our results are consistent with a recent publication from Magnus and colleagues, which found vaccination was not associated with congenital anomalies among 152 261 live births in Norway, Sweden, and Denmark, including 29 135 with first trimester mRNA COVID-19 vaccine exposures. While accumulating evidence supports the safety of first trimester COVID-19 vaccination, we disagree with Triunfo and Boselli that our study “encourages vaccination against COVID-19 in early pregnancy.” Additional data on the benefits of vaccination by trimester or gestational week, considering a range of maternal and infant outcomes, would be needed to specifically endorse COVID-19 vaccination in early pregnancy vs administration later in pregnancy.

This Viewpoint discusses the shortage of penicillin G benzathine during a surge in congenital syphilis cases in the US.

This randomized clinical trial investigates the effect of a parent-administered screen time intervention in the hour before bed on objectively measured toddler sleep and attention.

This cohort study uses data from the Children With Vesicoureteral Reflux trial to assess estimated glomerular filtration rate (eGFR) changes in participants with vs without recurrent urinary tract infections.

Pregnancy and infant health outcomes in the US continue to lag behind other countries with similar economic performance, with rates of infant and neonatal mortality and preterm birth typically 2 to 3 times higher than that of other high-income nations. These adverse outcomes also differentially occur in patients by race, ethnicity, socioeconomic status, or rural vs urban residence. As a result, there have been myriad programs and policies enacted on the state or local levels to address, and hopefully improve, the ultimate health of pregnant patients, newborns, and infants. Unfortunately, there is little information to help guide policymakers, advocates, or clinicians on the population health impact of such programs. The article by Chang et al provides some evidence that state-level policies may influence pregnancy and newborn outcomes. This study calculated yearly state and local government expenditures per person with low income in multiple social programs, including state refundable earned income tax credits, cash assistance, childcare assistance, housing and community development, and public health. They found that, for every increase of $1000 per person with low income, overall rates of preterm birth, defined as delivery of a live-born infant at a gestational age of less than 37 weeks, was decreased by 1.4%. This effect was larger in infants of Black mothers and for expenditures in cash assistance, housing, and community development. Such research suggests that public policies on social programs may have short- and long-term impacts on infant health and may impact specific infant populations to a greater degree.

Parents and caregivers of young children are often preoccupied with 2 separate challenges: how to get their kids off screens and how to improve sleep. The recent study by Pickard et al indicates that reducing before-bed screen use may help with some sleep outcomes among toddlers. In their UK-based study, Pickard et al conducted a randomized clinical trial (RCT) of a 7-week parent-administered screen time intervention (PASTI) in a sample of 105 families with children aged 16 to 30 months. The PASTI intervention was modeled after a related intervention for older children and cocreated with parents and early childhood practitioners, a notable study strength. PASTI involves instructing parents to remove all screen time in the hour before bed by providing a “bedtime box” with alternative activities, in addition to weekly text reminders. The RCT demonstrated surprising PASTI intervention feasibility, with 94% of families adhering to the intervention. They found small to medium effects of the PASTI intervention reducing before-bed screen time and increasing sleep efficiency with marginally significant reductions in nighttime awakenings. Unexpectedly, daytime naps marginally reduced, and there were no significant effects on objectively measured nighttime sleep duration nor attention. The major strengths of this well-executed study include the 3-arm triple-blinded RCT study design, in addition to objective measurement of both sleep (with actigraphy) and attention (with eye tracking). The authors also noted appropriate caution in interpreting the results, including the lack of objective assessment of screen time and being underpowered for an efficacy study.

This cross-sectional study assesses fatal drug overdoses in youths associated with implementation of state-level naloxone access expansions.

Children today are growing up in a world that feels increasingly polarized and at risk from natural and manufactured threats, such as poverty, pandemics, war, and climate change. They face increasing mortality rates in 44 of 50 states. Many children live in neighborhoods with limited access to healthy foods and associated higher rates of obesity. All live on a planet where hotter temperatures are linked to adverse health outcomes. When daily news feels like a litany of pessimism, science offers the agency to identify problems and the optimism to test solutions. Research can contribute to positive policy change by providing rigorous evidence to guide decision-making. In this spirit, JAMA Pediatrics has published timely research under the “Health and the 2024 US Election” theme. As was done for the 2020 election and in conjunction with other JAMA Network journals, we have assembled 23 articles describing empirical studies on topics highly relevant to the issues being debated across the US in the 2024 election.

This cohort study uses a propensity score–matched analysis to assess suicidal ideation or attempts following exposure to glucagon-like peptide 1 receptor agonists (GLP1R) in adolescents with obesity.

This time series analysis assesses trends in infant mortality after the Dobbs decision overturned the constitutional right to abortion.

This quality improvement study evaluates the use of direct graded oral challenge to confirm suspected macrolide allergy in children.

This cross-sectional study examines the incidence of juvenile-onset recurrent respiratory papillomatosis and HPV vaccination rates from 2007 to 2022 in the US.

This cohort study evaluates differences in epigenetic age acceleration by race and ethnicity.

To the Editor The article by Kharbanda et al reported the absence of any significant association between messenger RNA (mRNA) COVID-19 vaccine in the first trimester and increased risk for selected major structural birth defects in a large multisite cohort including 42 156 live-born infants in US. This study encourages vaccination against COVID-19 in early pregnancy by demonstrating its safety in terms of appropriate anatomic development among the offspring of recipients.

This Viewpoint describes the problems with litigation related to infant formula and necrotizing enterocolitis, such as the inadequacy of the evidence and the patient safety issues raised by the court’s rulings.

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.