Pub Date : 2025-11-24DOI: 10.1001/jamapediatrics.2025.4786
Ludvig Daae Bjørndal,Elizabeth C Corfield,Laurie J Hannigan,Ziada Ayorech,Cynthia M Bulik,Hunna J Watson,Lisa Dinkler,Samuel J R A Chawner,Stefan Johansson,Ole A Andreassen,Helga Ask,Alexandra Havdahl
ImportanceA narrow range of food consumption and/or restricted eating is a core feature of avoidant/restrictive food intake (ARFI) disorder. However, there is limited knowledge of developmental characteristics of children with ARFI and its etiological influences, which constrains research, prevention, and intervention efforts.ObjectiveTo estimate the prevalence of ARFI phenotypes in a population-based sample, examine developmental characteristics across childhood, and investigate the genetic architecture of ARFI using genome-wide association analyses.Design, Setting, and ParticipantsThis preregistered study used data from children born from 1999 to 2009 in the population-based Norwegian Mother, Father, and Child Cohort Study (MoBa), with mother-reported data on ARFI symptoms at 3 and 8 years and linkage with diagnostic data from population health registries. Data were analyzed from March 2024 to May 2025.ExposuresMultiple items were used to identify children with broad ARFI. These children were subclassified into 3 groups based on symptom persistence: ARFI-broad transient (only at age 3 years), emergent (only at age 8 years), and persistent (ages 3 and 8 years). Children in these groups with 1 or more indicators of clinical significance (eg, nutritional deficiency) were further classified into ARFI-clinical subgroups.Main Outcomes and MeasuresARFI groups were compared across developmental characteristics from 6 months to 14 years. Genome-wide methods were used to examine single-nucleotide variant (SNV) heritability (SNV-h2), conduct genetic association analyses, and quantify genetic correlations with other phenotypes.ResultsOf 35 751 children with available ARFI assessments at 3 and 8 years (18 236 male [51%]), the prevalence of ARFI-broad persistent, transient, and emergent was 2129 (6.0%), 6338 (17.7%), and 3001 (8.4%), respectively. The prevalence of ARFI-clinical persistent, transient, and emergent was 624 (1.8%), 1157 (3.2%), and 484 (1.4%), respectively (2265 [6.3%] overall). Children with ARFI-broad persistent exhibited more developmental difficulties compared with children with no ARFI. SNV-h2 ranged from 8% to 16%. Two independent genome-wide significant loci were identified. For ARFI-clinical, a significant association was identified with ADCY3 (z = 5.42; P = 3.03 × 10-8). Small to moderate genetic correlations were observed for ARFI-broad, ARFI-clinical and mental health, cognitive/educational, anthropometric, food-associated, and gastrointestinal disorder phenotypes.Conclusions and RelevanceThis cohort study found that the prevalence of ARFI in the general pediatric population was substantial, and affected children had an associated elevated risk of developmental difficulties across multiple domains. Findings suggest a need for broad support interventions and advance understanding of the genetic underpinnings of ARFI.
{"title":"Prevalence, Characteristics, and Genetic Architecture of Avoidant/Restrictive Food Intake Phenotypes.","authors":"Ludvig Daae Bjørndal,Elizabeth C Corfield,Laurie J Hannigan,Ziada Ayorech,Cynthia M Bulik,Hunna J Watson,Lisa Dinkler,Samuel J R A Chawner,Stefan Johansson,Ole A Andreassen,Helga Ask,Alexandra Havdahl","doi":"10.1001/jamapediatrics.2025.4786","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4786","url":null,"abstract":"ImportanceA narrow range of food consumption and/or restricted eating is a core feature of avoidant/restrictive food intake (ARFI) disorder. However, there is limited knowledge of developmental characteristics of children with ARFI and its etiological influences, which constrains research, prevention, and intervention efforts.ObjectiveTo estimate the prevalence of ARFI phenotypes in a population-based sample, examine developmental characteristics across childhood, and investigate the genetic architecture of ARFI using genome-wide association analyses.Design, Setting, and ParticipantsThis preregistered study used data from children born from 1999 to 2009 in the population-based Norwegian Mother, Father, and Child Cohort Study (MoBa), with mother-reported data on ARFI symptoms at 3 and 8 years and linkage with diagnostic data from population health registries. Data were analyzed from March 2024 to May 2025.ExposuresMultiple items were used to identify children with broad ARFI. These children were subclassified into 3 groups based on symptom persistence: ARFI-broad transient (only at age 3 years), emergent (only at age 8 years), and persistent (ages 3 and 8 years). Children in these groups with 1 or more indicators of clinical significance (eg, nutritional deficiency) were further classified into ARFI-clinical subgroups.Main Outcomes and MeasuresARFI groups were compared across developmental characteristics from 6 months to 14 years. Genome-wide methods were used to examine single-nucleotide variant (SNV) heritability (SNV-h2), conduct genetic association analyses, and quantify genetic correlations with other phenotypes.ResultsOf 35 751 children with available ARFI assessments at 3 and 8 years (18 236 male [51%]), the prevalence of ARFI-broad persistent, transient, and emergent was 2129 (6.0%), 6338 (17.7%), and 3001 (8.4%), respectively. The prevalence of ARFI-clinical persistent, transient, and emergent was 624 (1.8%), 1157 (3.2%), and 484 (1.4%), respectively (2265 [6.3%] overall). Children with ARFI-broad persistent exhibited more developmental difficulties compared with children with no ARFI. SNV-h2 ranged from 8% to 16%. Two independent genome-wide significant loci were identified. For ARFI-clinical, a significant association was identified with ADCY3 (z = 5.42; P = 3.03 × 10-8). Small to moderate genetic correlations were observed for ARFI-broad, ARFI-clinical and mental health, cognitive/educational, anthropometric, food-associated, and gastrointestinal disorder phenotypes.Conclusions and RelevanceThis cohort study found that the prevalence of ARFI in the general pediatric population was substantial, and affected children had an associated elevated risk of developmental difficulties across multiple domains. Findings suggest a need for broad support interventions and advance understanding of the genetic underpinnings of ARFI.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1001/jamapediatrics.2025.4840
Marion E Granger Howard,Ciaran S Phibbs,Scott Lorch,Molly Passarella,Nansi S Boghossian
ImportanceStudies examining community births (ie, births that occur outside of a hospital setting, such as at home or in a birth center) often misclassify transfers to hospitals as hospital births. Oregon uniquely tracks planned birth location at labor onset.ObjectivesTo examine the association between planned place of delivery and perinatal outcomes in Oregon.Design, Setting, and ParticipantsThis was a population-based cohort study of singleton, nonbreech infants without lethal anomalies born at 37 to 44 weeks' gestation in Oregon between January 2012 and December 2020. Data were analyzed from October 2023 to September 2025.ExposuresPlanned hospital births vs planned community births, including completed community deliveries at home or a birthing center and those resulting in hospital transfer.Main Outcomes and MeasuresOutcomes included fetal, neonatal, and infant death; 5-minute APGAR (appearance, pulse, grimace, activity, and respiration) scores less than 7 or less than 4; neonatal seizure; ventilator support; neonatal intensive care unit admission; delivery procedures; maternal intensive care unit admission; maternal blood transfusion; and severe perineal lacerations. Adjusted logistic regression models were used to determine the association between planned community or planned hospital births and perinatal outcomes. Propensity score analysis was conducted to account for overall differences in measured covariates between groups.ResultsAmong 348 641 birthing individuals (mean [SD] age, 29.0 [5.8] years [77.3%]; 7383 non-Hispanic Black [2.1%], 66 013 Hispanic [18.9%], 235 269 non-Hispanic White [67.6%], and 38 668 [11.1%] other, including Asian/Pacific Islander, American Indian or Alaska Native, and multiple races), 332 313 planned to deliver in a hospital (95.3%) and 16 328 planned to have a community birth (4.7%). There were 2402 planned community births that were transferred to a hospital for delivery (14.7%). Compared to planned hospital births, planned community births had higher odds of 5-minute APGAR score less than 7 (adjusted odds ratio [aOR], 1.34; 95% CI, 1.19-1.50) and ventilator support (aOR, 1.14; 95% CI, 1.05-1.24). Transferred deliveries had increased odds of most adverse outcomes and medical interventions, whereas completed community births were not associated with most perinatal outcomes and had lower odds of most medical interventions. Propensity score-adjusted results aligned with the main findings.Conclusions and RelevanceWhile the risks of perinatal outcomes and likelihood of interventions were generally reduced in completed community births, transferred deliveries had higher odds of most perinatal outcomes and interventions. Misclassifying transfers as hospital births may mask risks associated with planned community births. These risks should be clearly communicated during patient counseling and considered in policy decisions.
{"title":"Planned Community Birth and Birth Outcomes.","authors":"Marion E Granger Howard,Ciaran S Phibbs,Scott Lorch,Molly Passarella,Nansi S Boghossian","doi":"10.1001/jamapediatrics.2025.4840","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4840","url":null,"abstract":"ImportanceStudies examining community births (ie, births that occur outside of a hospital setting, such as at home or in a birth center) often misclassify transfers to hospitals as hospital births. Oregon uniquely tracks planned birth location at labor onset.ObjectivesTo examine the association between planned place of delivery and perinatal outcomes in Oregon.Design, Setting, and ParticipantsThis was a population-based cohort study of singleton, nonbreech infants without lethal anomalies born at 37 to 44 weeks' gestation in Oregon between January 2012 and December 2020. Data were analyzed from October 2023 to September 2025.ExposuresPlanned hospital births vs planned community births, including completed community deliveries at home or a birthing center and those resulting in hospital transfer.Main Outcomes and MeasuresOutcomes included fetal, neonatal, and infant death; 5-minute APGAR (appearance, pulse, grimace, activity, and respiration) scores less than 7 or less than 4; neonatal seizure; ventilator support; neonatal intensive care unit admission; delivery procedures; maternal intensive care unit admission; maternal blood transfusion; and severe perineal lacerations. Adjusted logistic regression models were used to determine the association between planned community or planned hospital births and perinatal outcomes. Propensity score analysis was conducted to account for overall differences in measured covariates between groups.ResultsAmong 348 641 birthing individuals (mean [SD] age, 29.0 [5.8] years [77.3%]; 7383 non-Hispanic Black [2.1%], 66 013 Hispanic [18.9%], 235 269 non-Hispanic White [67.6%], and 38 668 [11.1%] other, including Asian/Pacific Islander, American Indian or Alaska Native, and multiple races), 332 313 planned to deliver in a hospital (95.3%) and 16 328 planned to have a community birth (4.7%). There were 2402 planned community births that were transferred to a hospital for delivery (14.7%). Compared to planned hospital births, planned community births had higher odds of 5-minute APGAR score less than 7 (adjusted odds ratio [aOR], 1.34; 95% CI, 1.19-1.50) and ventilator support (aOR, 1.14; 95% CI, 1.05-1.24). Transferred deliveries had increased odds of most adverse outcomes and medical interventions, whereas completed community births were not associated with most perinatal outcomes and had lower odds of most medical interventions. Propensity score-adjusted results aligned with the main findings.Conclusions and RelevanceWhile the risks of perinatal outcomes and likelihood of interventions were generally reduced in completed community births, transferred deliveries had higher odds of most perinatal outcomes and interventions. Misclassifying transfers as hospital births may mask risks associated with planned community births. These risks should be clearly communicated during patient counseling and considered in policy decisions.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"112 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1001/jamapediatrics.2025.4771
Ravi Savarirayan, Ciara McDonnell, Carlos A. Bacino, Daniel G. Hoernschemeyer, Janet M. Legare, M. Jennifer Abuzzahab, Paul L. Hofman, Philippe M. Campeau, Josep Maria de Bergua Domingo, Leanne M. Ward, Kevin Smit, Alden Smith, Meng Mao, Michael S. Ominsky, Lærke C. Freiberg, Aimee D. Shu, Hanne B. Hove
Importance Historically considered a skeletal dysplasia characterized by disproportionate short stature, achondroplasia is a condition with multisystemic effects due to the widespread expression of the fibroblast growth factor receptor 3 variant throughout the body, impacting muscle, neurological function, cardiorespiratory health, and health-related quality of life. Objective To evaluate the efficacy, safety, and tolerability of once-weekly navepegritide, an investigational prodrug of C-type natriuretic peptide, while assessing benefits beyond growth that may have important implications for complications and health-related quality of life in children with achondroplasia. Design, Setting, and Participants Enrollment for this pivotal phase 2b, randomized, double-blind, placebo-controlled trial (APPROACH) was conducted between March and August 2023 at 10 hospitals in Australia, Canada, Denmark, Ireland, New Zealand, Spain, and the US with randomized, blind treatment through 52 weeks and an open-label extension (ongoing). Eligible participants aged 2 to 11 years had achondroplasia confirmed by genetic testing, were naive to treatment with growth-promoting agents, and had their height recorded at least 6 months prior to randomization. Enrolled participants were stratified by age and sex. Those with radiographic evidence of closed growth plates, planned bone surgery, severe untreated sleep apnea, or medical conditions known to affect growth were excluded (n = 2 of 86); of 84 participants enrolled, all were analyzed for safety and efficacy outcomes, including 2 who discontinued treatment. Interventions Navepegritide (100 μg/kg/wk) or placebo administered by once-weekly subcutaneous injection. Main Outcomes and Measures The primary end point was annualized growth velocity at week 52. Other clinically important secondary measures included radiographically assessed skeletal outcomes and health-related quality of life, evaluated using Achondroplasia Child Experience Measures. Safety assessments included adverse events, clinical laboratory assessments, bone age, and immunogenicity. Results Eighty-four participants were enrolled and assigned randomly in a 2:1 ratio to receive navepegritide (n = 57; mean [SD] age, 5.6 [2.6] years; 31 [54%] male) or placebo (n = 27; mean [SD] age, 6.0 [2.7] years; 14 [52%] male). All randomized participants were included in efficacy and safety analyses, although 2 patients in the navepegritide group discontinued treatment (one at week 26 and the other at week 34). The trial met its primary end point, demonstrating superiority of navepegritide in annualized growth velocity at week 52 vs placebo (least-squares mean treatment difference of 1.49 cm/y; 95% CI, 1.05 to 1.93; <jats:italic>P</jats:italic> &lt; .001). Treatment resulted in improvements (least-squares mean treatment difference [95% CI]) in tibial-femoral angle (−1.81° [−3.16 to −0.47]), mechanical axis deviation (−2.78 mm [−4.71 to −0.86]), fibula to tibia lengt
{"title":"Once-Weekly Navepegritide in Children With Achondroplasia","authors":"Ravi Savarirayan, Ciara McDonnell, Carlos A. Bacino, Daniel G. Hoernschemeyer, Janet M. Legare, M. Jennifer Abuzzahab, Paul L. Hofman, Philippe M. Campeau, Josep Maria de Bergua Domingo, Leanne M. Ward, Kevin Smit, Alden Smith, Meng Mao, Michael S. Ominsky, Lærke C. Freiberg, Aimee D. Shu, Hanne B. Hove","doi":"10.1001/jamapediatrics.2025.4771","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4771","url":null,"abstract":"Importance Historically considered a skeletal dysplasia characterized by disproportionate short stature, achondroplasia is a condition with multisystemic effects due to the widespread expression of the fibroblast growth factor receptor 3 variant throughout the body, impacting muscle, neurological function, cardiorespiratory health, and health-related quality of life. Objective To evaluate the efficacy, safety, and tolerability of once-weekly navepegritide, an investigational prodrug of C-type natriuretic peptide, while assessing benefits beyond growth that may have important implications for complications and health-related quality of life in children with achondroplasia. Design, Setting, and Participants Enrollment for this pivotal phase 2b, randomized, double-blind, placebo-controlled trial (APPROACH) was conducted between March and August 2023 at 10 hospitals in Australia, Canada, Denmark, Ireland, New Zealand, Spain, and the US with randomized, blind treatment through 52 weeks and an open-label extension (ongoing). Eligible participants aged 2 to 11 years had achondroplasia confirmed by genetic testing, were naive to treatment with growth-promoting agents, and had their height recorded at least 6 months prior to randomization. Enrolled participants were stratified by age and sex. Those with radiographic evidence of closed growth plates, planned bone surgery, severe untreated sleep apnea, or medical conditions known to affect growth were excluded (n = 2 of 86); of 84 participants enrolled, all were analyzed for safety and efficacy outcomes, including 2 who discontinued treatment. Interventions Navepegritide (100 μg/kg/wk) or placebo administered by once-weekly subcutaneous injection. Main Outcomes and Measures The primary end point was annualized growth velocity at week 52. Other clinically important secondary measures included radiographically assessed skeletal outcomes and health-related quality of life, evaluated using Achondroplasia Child Experience Measures. Safety assessments included adverse events, clinical laboratory assessments, bone age, and immunogenicity. Results Eighty-four participants were enrolled and assigned randomly in a 2:1 ratio to receive navepegritide (n = 57; mean [SD] age, 5.6 [2.6] years; 31 [54%] male) or placebo (n = 27; mean [SD] age, 6.0 [2.7] years; 14 [52%] male). All randomized participants were included in efficacy and safety analyses, although 2 patients in the navepegritide group discontinued treatment (one at week 26 and the other at week 34). The trial met its primary end point, demonstrating superiority of navepegritide in annualized growth velocity at week 52 vs placebo (least-squares mean treatment difference of 1.49 cm/y; 95% CI, 1.05 to 1.93; <jats:italic>P</jats:italic> &amp;lt; .001). Treatment resulted in improvements (least-squares mean treatment difference [95% CI]) in tibial-femoral angle (−1.81° [−3.16 to −0.47]), mechanical axis deviation (−2.78 mm [−4.71 to −0.86]), fibula to tibia lengt","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"5 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1001/jamapediatrics.2025.4627
Elizabeth L. Cope, Aaron E. Carroll
This Viewpoint describes how recent US political actions are undermining science, identifies vulnerabilities of the scientific enterprise, and emphasizes the urgency of taking action to safeguard science.
{"title":"Safeguarding Science—The Time Is Now","authors":"Elizabeth L. Cope, Aaron E. Carroll","doi":"10.1001/jamapediatrics.2025.4627","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4627","url":null,"abstract":"This Viewpoint describes how recent US political actions are undermining science, identifies vulnerabilities of the scientific enterprise, and emphasizes the urgency of taking action to safeguard science.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"168 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1001/jamapediatrics.2025.4709
Jacquelyn Harverson, Jeromy Anglim, Louise Paatsch, Sharon Horwood
Importance Current guidelines recommend screen time limitations for young children in favor of their ongoing development and well-being. Distinguishing momentary patterns of screen use in relation to childhood well-being will further inform screen time recommendations to better reflect contemporary childhood digital experiences. Objective To investigate the associations between momentary children’s screen use, parent-child interactions, emotions, and externalizing behavior. Design, Setting, and Participants In this ecological momentary assessment (EMA) study, parent-reported methodology was used to measure children’s screen-based experiences. Reporting on the last hour, assessments were provided up to 3 times per weekday and 5 times per weekend day, across a 2-week period from May to November 2024. Parents completed momentary assessments in their everyday environments, capturing typical fluctuations in children’s habits, emotions, and behaviors. Participants identified as parents of children in the first 3 years of formal schooling. Exposure Children’s use of screens including screen use, duration, activities, and solo vs co-use details. Main Outcomes and Measures Children’s momentary affect, externalizing behaviors, and parent-child interactions were measured using subsets of items from the Positive and Negative Affect Schedule Short form, the Strengths and Difficulties Questionnaire, and the Child Parent Relationship Scale—Short form, respectively. Results A total of 934 momentary assessments from 42 parents (mean [SD] age, 38.7 [4.9] years; 33 female [79%]) of children (mean [SD] age, 6.4 [1.2] years; 24 male [57%];) were included in analyses. Multilevel modeling indicated screen use duration was associated with lower levels of both positive affect ( b = −0.16; 95% CI, −0.30 to −0.02; estimating screen time b = −0.05; 95% CI, −0.08 to −0.01) and negative affect ( b = −0.12; 95% CI, −0.24 to −0.01; estimating screen time b = −0.10; 95% CI, −0.15 to −0.06). Interactive activities ( b = 0.26; 95% CI, 0.04-0.47) and co-use ( b = 0.17; 95% CI, 0-0.34) were significantly associated with positive affect. Parent-child interactions negatively estimated screen use duration ( b = −0.07; 95% CI, −0.13 to −0.02). Conclusions and Relevance Results of this study suggest that the associations between children’s digital experiences and well-being are complex and bidirectional. The momentary associations found in this study provide evidence for moving beyond duration-focused recommendations toward context-sensitive guidelines that consider the dynamic nature of children’s digital experiences.
{"title":"Ecological Momentary Assessment Study of Digital Technology Use and Child Well-Being","authors":"Jacquelyn Harverson, Jeromy Anglim, Louise Paatsch, Sharon Horwood","doi":"10.1001/jamapediatrics.2025.4709","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4709","url":null,"abstract":"Importance Current guidelines recommend screen time limitations for young children in favor of their ongoing development and well-being. Distinguishing momentary patterns of screen use in relation to childhood well-being will further inform screen time recommendations to better reflect contemporary childhood digital experiences. Objective To investigate the associations between momentary children’s screen use, parent-child interactions, emotions, and externalizing behavior. Design, Setting, and Participants In this ecological momentary assessment (EMA) study, parent-reported methodology was used to measure children’s screen-based experiences. Reporting on the last hour, assessments were provided up to 3 times per weekday and 5 times per weekend day, across a 2-week period from May to November 2024. Parents completed momentary assessments in their everyday environments, capturing typical fluctuations in children’s habits, emotions, and behaviors. Participants identified as parents of children in the first 3 years of formal schooling. Exposure Children’s use of screens including screen use, duration, activities, and solo vs co-use details. Main Outcomes and Measures Children’s momentary affect, externalizing behaviors, and parent-child interactions were measured using subsets of items from the Positive and Negative Affect Schedule Short form, the Strengths and Difficulties Questionnaire, and the Child Parent Relationship Scale—Short form, respectively. Results A total of 934 momentary assessments from 42 parents (mean [SD] age, 38.7 [4.9] years; 33 female [79%]) of children (mean [SD] age, 6.4 [1.2] years; 24 male [57%];) were included in analyses. Multilevel modeling indicated screen use duration was associated with lower levels of both positive affect ( <jats:italic toggle=\"yes\">b</jats:italic> = −0.16; 95% CI, −0.30 to −0.02; estimating screen time <jats:italic toggle=\"yes\">b</jats:italic> = −0.05; 95% CI, −0.08 to −0.01) and negative affect ( <jats:italic toggle=\"yes\">b</jats:italic> = −0.12; 95% CI, −0.24 to −0.01; estimating screen time <jats:italic toggle=\"yes\">b</jats:italic> = −0.10; 95% CI, −0.15 to −0.06). Interactive activities ( <jats:italic toggle=\"yes\">b</jats:italic> = 0.26; 95% CI, 0.04-0.47) and co-use ( <jats:italic toggle=\"yes\">b</jats:italic> = 0.17; 95% CI, 0-0.34) were significantly associated with positive affect. Parent-child interactions negatively estimated screen use duration ( <jats:italic toggle=\"yes\">b</jats:italic> = −0.07; 95% CI, −0.13 to −0.02). Conclusions and Relevance Results of this study suggest that the associations between children’s digital experiences and well-being are complex and bidirectional. The momentary associations found in this study provide evidence for moving beyond duration-focused recommendations toward context-sensitive guidelines that consider the dynamic nature of children’s digital experiences.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"93 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1001/jamapediatrics.2025.4537
Jay G. Berry, Derek J. Williams, S. Margaret Wright, Lee M. Sanders, Dishita Agarwal, Carolyn Foster, Jaclyn Vasquez, James M. Perrin, Stephanie Lomangino, Matthew Hall
This study examines current system-level and patient-level characteristics of pediatric hospitalizations and the Medicaid impact on health care access for children and families.
本研究考察了当前儿科住院的系统水平和患者水平的特征，以及医疗补助对儿童和家庭医疗保健获取的影响。
{"title":"US Pediatric Hospitalizations Among Children Enrolled in Medicaid","authors":"Jay G. Berry, Derek J. Williams, S. Margaret Wright, Lee M. Sanders, Dishita Agarwal, Carolyn Foster, Jaclyn Vasquez, James M. Perrin, Stephanie Lomangino, Matthew Hall","doi":"10.1001/jamapediatrics.2025.4537","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4537","url":null,"abstract":"This study examines current system-level and patient-level characteristics of pediatric hospitalizations and the Medicaid impact on health care access for children and families.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"64 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1001/jamapediatrics.2025.4653
Amitai S. Miller, Michael Liu, Rita Graham, Nicholas L. Berlin, Katherine H. Carruthers, Alex S. Keuroghlian
Importance Gender-affirming care (GAC) improves the mental health and well-being of transgender and gender-diverse people. In January 2025, the Trump administration announced major National Institutes of Health (NIH) grant terminations, specifically aimed at defunding research related to transgender populations. Objective To examine the scope, timing, and financial impact of NIH GAC grant terminations. Design, Setting, and Participants This was a cross-sectional study of terminated and active federal research grants administered by the NIH, identified through the Grant Witness and NIH RePORTER databases. Inclusion criteria required that grants involve GAC outcomes or research related to its access or provision. Data were collected on May 12, 2025, and included funding status, dates of termination, and grant characteristics. Exposure Termination of NIH grants related to GAC. Main Outcomes and Measures Primary outcomes included the number and proportion of terminated grants, total funding lost, date of termination, and study focus. Results Of 64 identified NIH grants related to GAC, 41 (64.1%) were terminated within a 3-week span ranging from March 3 to March 21, 2025. Among these terminated grants, 46.9% of their combined funding remained unspent at the time of cancellation, amounting to nearly $22 million lost in research dollars. Of the research topics that were terminated, the largest proportion focused on the interaction of GAC with physical health conditions (eg, breast cancer, HIV, cardiovascular outcomes). Conclusions and Relevance Findings of this study illustrate the scope and depth of a targeted disruption to a vital area of scientific inquiry and health equity, emphasizing the need for insulated funding streams to preserve ongoing GAC research.
{"title":"Termination of Gender-Affirming Care Grants at the National Institutes of Health","authors":"Amitai S. Miller, Michael Liu, Rita Graham, Nicholas L. Berlin, Katherine H. Carruthers, Alex S. Keuroghlian","doi":"10.1001/jamapediatrics.2025.4653","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4653","url":null,"abstract":"Importance Gender-affirming care (GAC) improves the mental health and well-being of transgender and gender-diverse people. In January 2025, the Trump administration announced major National Institutes of Health (NIH) grant terminations, specifically aimed at defunding research related to transgender populations. Objective To examine the scope, timing, and financial impact of NIH GAC grant terminations. Design, Setting, and Participants This was a cross-sectional study of terminated and active federal research grants administered by the NIH, identified through the Grant Witness and NIH RePORTER databases. Inclusion criteria required that grants involve GAC outcomes or research related to its access or provision. Data were collected on May 12, 2025, and included funding status, dates of termination, and grant characteristics. Exposure Termination of NIH grants related to GAC. Main Outcomes and Measures Primary outcomes included the number and proportion of terminated grants, total funding lost, date of termination, and study focus. Results Of 64 identified NIH grants related to GAC, 41 (64.1%) were terminated within a 3-week span ranging from March 3 to March 21, 2025. Among these terminated grants, 46.9% of their combined funding remained unspent at the time of cancellation, amounting to nearly $22 million lost in research dollars. Of the research topics that were terminated, the largest proportion focused on the interaction of GAC with physical health conditions (eg, breast cancer, HIV, cardiovascular outcomes). Conclusions and Relevance Findings of this study illustrate the scope and depth of a targeted disruption to a vital area of scientific inquiry and health equity, emphasizing the need for insulated funding streams to preserve ongoing GAC research.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"127 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1001/jamapediatrics.2025.4502
Jason M Nagata,Zain Memon,Oliver Huang,Megan A Moreno
{"title":"Adolescent Health and Generative AI-Risks and Benefits.","authors":"Jason M Nagata,Zain Memon,Oliver Huang,Megan A Moreno","doi":"10.1001/jamapediatrics.2025.4502","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4502","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1001/jamapediatrics.2025.4487
Richard T Liu,Rachel Y Levin,Margarid R Turnamian
ImportanceChild abuse and neglect are associated with risk of negative health outcomes, and children in minoritiy racial and ethnic groups and female children are disproportionately affected. It is unclear whether the incidence of child maltreatment has changed over time.ObjectiveTo determine whether incidence of child maltreatment and its subtypes changed across sex, race, and ethnicity in the US from 2012 through 2023.Design, Settings, and ParticipantsIn this serial, population-based, cross-sectional study, all Child Protective Services cases in the US from January 2012 through December 2023 for children from birth to age 17 years were drawn from the National Child Abuse and Neglect Data System. Race and ethnicity were recorded as per the data system. Population estimates of US children for corresponding years were from the US Census Bureau.Main Outcomes and MeasuresConfirmed and referred cases of emotional abuse, physical abuse, sexual abuse, and neglect per 10 000 children by race, ethnicity, and sex.ResultsFrom 2012 through 2023, there were 7 326 987 confirmed cases (per 10 000 children: 87.51 female and 78.46 male; 79.52 American Indian and Alaska Native, 17.72 Asian, Native Hawaiian, Pacific Islander, 121.69 Black, 67.21 White, 91.22 of multiple races, and 75.72 Hispanic) and 32 980 613 referrals (per 10 000 children: 382.72 female and 361.35 male; 293.45 American Indian and Alaska Native, 88.81 Asian, Native Hawaiian, Pacific Islander, 550.54 Black, 294.80 White, 358.08 of multiple races, and 313.43 Hispanic) for child maltreatment. Overall, confirmed cases of all forms of maltreatment declined (average annual percent change [AAPC], -1.53; 95% CI, -2.07 to -1.05), except for sexual abuse, and remained unchanged for referrals (overall maltreatment AAPC, 0.11; 95% CI, -0.33 to 0.58). Decline in most confirmed subtypes of maltreatment was found for Asian, Native Hawaiian, and Other Pacific Islander (overall maltreatment AAPC, -1.77; 95% CI, -3.17 to -0.58), Hispanic (overall maltreatment AAPC, -1.81; 95% CI, -2.67 to -1.13), and White (overall maltreatment AAPC, -0.74; 95% CI, -1.08 to -0.42) children. Disparities persisted across the study period; incidence was lowest for all maltreatment subtypes among Asian, Native Hawaiian, and Other Pacific Islander children and generally highest among Black children. Both sexes experienced mostly decreases in confirmed cases and no changes in referrals for maltreatment overall (confirmed overall female maltreatment AAPC, -1.25; 95% CI, -1.64 to -0.90 and confirmed overall male maltreatment AAPC, -1.81, 95% CI, -2.53 to -1.21), but female children experienced more maltreatment, with disparities largest and widening over time for sexual abuse (z score, 5.52; P < .001).Conclusions and RelevanceIn this study, child maltreatment declined for confirmed cases and remain unchanged for referrals. Disparities persisted, particularly for Black children. This group with the most room for improvement experienced no
{"title":"A Whole-Population Study of National Trends in Child Abuse and Neglect by Sex, Race, and Ethnicity in the US.","authors":"Richard T Liu,Rachel Y Levin,Margarid R Turnamian","doi":"10.1001/jamapediatrics.2025.4487","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4487","url":null,"abstract":"ImportanceChild abuse and neglect are associated with risk of negative health outcomes, and children in minoritiy racial and ethnic groups and female children are disproportionately affected. It is unclear whether the incidence of child maltreatment has changed over time.ObjectiveTo determine whether incidence of child maltreatment and its subtypes changed across sex, race, and ethnicity in the US from 2012 through 2023.Design, Settings, and ParticipantsIn this serial, population-based, cross-sectional study, all Child Protective Services cases in the US from January 2012 through December 2023 for children from birth to age 17 years were drawn from the National Child Abuse and Neglect Data System. Race and ethnicity were recorded as per the data system. Population estimates of US children for corresponding years were from the US Census Bureau.Main Outcomes and MeasuresConfirmed and referred cases of emotional abuse, physical abuse, sexual abuse, and neglect per 10 000 children by race, ethnicity, and sex.ResultsFrom 2012 through 2023, there were 7 326 987 confirmed cases (per 10 000 children: 87.51 female and 78.46 male; 79.52 American Indian and Alaska Native, 17.72 Asian, Native Hawaiian, Pacific Islander, 121.69 Black, 67.21 White, 91.22 of multiple races, and 75.72 Hispanic) and 32 980 613 referrals (per 10 000 children: 382.72 female and 361.35 male; 293.45 American Indian and Alaska Native, 88.81 Asian, Native Hawaiian, Pacific Islander, 550.54 Black, 294.80 White, 358.08 of multiple races, and 313.43 Hispanic) for child maltreatment. Overall, confirmed cases of all forms of maltreatment declined (average annual percent change [AAPC], -1.53; 95% CI, -2.07 to -1.05), except for sexual abuse, and remained unchanged for referrals (overall maltreatment AAPC, 0.11; 95% CI, -0.33 to 0.58). Decline in most confirmed subtypes of maltreatment was found for Asian, Native Hawaiian, and Other Pacific Islander (overall maltreatment AAPC, -1.77; 95% CI, -3.17 to -0.58), Hispanic (overall maltreatment AAPC, -1.81; 95% CI, -2.67 to -1.13), and White (overall maltreatment AAPC, -0.74; 95% CI, -1.08 to -0.42) children. Disparities persisted across the study period; incidence was lowest for all maltreatment subtypes among Asian, Native Hawaiian, and Other Pacific Islander children and generally highest among Black children. Both sexes experienced mostly decreases in confirmed cases and no changes in referrals for maltreatment overall (confirmed overall female maltreatment AAPC, -1.25; 95% CI, -1.64 to -0.90 and confirmed overall male maltreatment AAPC, -1.81, 95% CI, -2.53 to -1.21), but female children experienced more maltreatment, with disparities largest and widening over time for sexual abuse (z score, 5.52; P < .001).Conclusions and RelevanceIn this study, child maltreatment declined for confirmed cases and remain unchanged for referrals. Disparities persisted, particularly for Black children. This group with the most room for improvement experienced no","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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