Pediatrics最新文献

{"title":"Growth of Children With Cerebral Palsy and Health Outcomes.","authors":"Richard D Stevenson,Mark R Conaway,Gordon Worley,Virginia A Stallings","doi":"10.1542/peds.2025-072504","DOIUrl":"https://doi.org/10.1542/peds.2025-072504","url":null,"abstract":"OBJECTIVEThe California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers.PATIENTS AND METHODSNAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities.RESULTSNAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2-14.8) more hospital stays (P < .001), 3.1 times (95% CI, 1.3-7.4) more missed regular programs (P < .001), and 2.8 times (95% CI, 1.2-6.5) more total days (P = .02) the family or child missed regular activities. TSF (fat stores) and severe feeding problems were associated independently with health and participation.CONCLUSIONThis study validates the CP growth charts and documents an association between GWt%-ile and markers of health and participation other than mortality. CP growth charts warrant consideration for clinical decision-making and research.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"12 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight and Health Outcomes in Cerebral Palsy: A Causality Dilemma.","authors":"Katherin E Portwood,Bhooma Aravamuthan","doi":"10.1542/peds.2025-074191","DOIUrl":"https://doi.org/10.1542/peds.2025-074191","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Hypertension Associated With Vitamin C Deficiency Is Rapidly Reversible.","authors":"Tomás Woodgate,Jay Patel,Thomas Day,Brodie Knight,Adriani Spanaki,Alistair Calder,Shahin Moledina,Sadia Quyam","doi":"10.1542/peds.2025-073645","DOIUrl":"https://doi.org/10.1542/peds.2025-073645","url":null,"abstract":"We report 4 children (aged 3-9 years) with severe pulmonary hypertension (PH) associated with vitamin C deficiency. All presented with either musculoskeletal symptoms or cardiorespiratory deterioration with peripheral edema. Multiple nutritional deficiencies were identified in all children, and 2 had autistic spectrum disorder. Initial echocardiography results demonstrated severe PH with right ventricular dysfunction and significantly elevated N-terminal pro-B-type natriuretic peptide levels. In 2 patients presenting with musculoskeletal symptoms, specialist radiologic review revealed subtle features of scurvy that provided early diagnostic clues before laboratory confirmation. Vitamin C levels were undetectable where samples were processed prior to replacement, highlighting the importance of securing viable samples before treatment initiation for diagnostic certainty. All children received vitamin C replacement therapy, with 3 also receiving concurrent sildenafil. Remarkably, all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months. Importantly, 1 child receiving sildenafil alone showed no therapeutic response until vitamin C was added, indicating that improvement requires correction of the underlying deficiency rather than pulmonary vasodilation alone. This case series demonstrates rapid reversibility of vitamin C deficiency-associated PH and emphasizes the importance of considering this diagnosis in children with restricted diets and unexplained PH.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Electronic Health Record-Based Tobacco Treatment System for Parents in Pediatric Primary Care.","authors":"Brian P Jenssen,Abra M Jeffers,Emara Nabi-Burza,Janani Ramachandran,Jeritt Thayer,Bethany Hipple Walters,Douglas E Levy,Robert W Grundmeier,Olivier Drouin,Mark Vangel,Nancy A Rigotti,Tyra Bryant-Stephens,Alexander G Fiks,Jonathan P Winickoff","doi":"10.1542/peds.2025-073934","DOIUrl":"https://doi.org/10.1542/peds.2025-073934","url":null,"abstract":"BACKGROUNDParental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care.METHODSWe conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period.RESULTSAmong 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%).CONCLUSIONSAn automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"15 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Auditory Brainstem Response to Predict Language Delay.","authors":"Patrick C M Wong,Shaoqi Pan,Ching Man Lai,Peggy H Y Chan,Gangyi Feng,Hugh Simon Lam,Tak Yeung Leung,Nikolay Novitskiy,Ting Fan Leung","doi":"10.1542/peds.2025-073409","DOIUrl":"https://doi.org/10.1542/peds.2025-073409","url":null,"abstract":"OBJECTIVEAlthough preterm birth is among the best predictors of language delay, it is not precise enough to make child-level prediction that will enable the prescription of the highly effective early intervention (EI). This study aims to develop and validate predictive models of language delay using neural data collected from as early as infancy to forecast language delay as to indicate EI before preschool years.METHODElectroencephalography (EEG) neural speech encoding (ie, \"speech auditory brainstem response [ABR]\") was recorded from 423 Chinese-learning infants between 1 and 24 months, and language outcomes were collected from the same children between 7 and 32 months in this cohort study. Data were collected from 2016 to 2024, with an analysis cutoff on October 3, 2024. Early-latency and long-latency EEG responses to 3 speech stimuli (2 native, 1 non-native) were collected. Model outcome was the language subscale of the Bayley Scales of Infant and Toddler Development, third edition.RESULTSRandom forest was used to classify children into binary groups based on outcome measure: below/at the 16th percentile vs above. Different predictive models were constructed and compared, including those with and without EEG and clinical measures. Models with non-neural measures (eg, gestational age and birth weight) predicted language outcomes above chance. Models with EEG measures alone outperformed any non-neural models, achieving sensitivity and area under the receiver operating characteristic curve (AUC) well above 90% for the best models. When EEG models were externally validated, sensitivity and AUC remained above 80% and 90%, respectively.CONCLUSIONSpeech ABR can be a novel screening tool for language delay, allowing families of screened children to adopt EI preemptively for enhanced language development.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"34 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guideline for Diagnosis and Management of Faltering Weight.","authors":"Hans B Kersten,Praveen S Goday,Ruba Abdelhadi,Soukaina Adolphe,Nicole Anania,David S Bennett,Leah W Burke,Catherine Larson-Nath,Teresa M Lee,Michael G Leu,Shelly Mercer,Timothy Sentongo,Joyee Goswami Vachani,Emily Senerth,Lauren Pilcher,Susan K Flinn,Kymika Okechukwu,Reem A Mustafa,Rebecca L Morgan, ","doi":"10.1542/peds.2025-075764","DOIUrl":"https://doi.org/10.1542/peds.2025-075764","url":null,"abstract":"This evidence-based guideline from the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition is intended to support health care providers who care for children with poor weight gain. This clinical practice guideline (CPG) panel updates the term \"failure to thrive\" to \"faltering weight\" and using z score cutoffs rather than percentiles as diagnostic criteria. A diagnosis of faltering weight includes any of the following: (1) weight-for-length or body mass index (BMI)-for-age less than -1.65 z score (5th percentile); (2) in children younger than 2 years, weight gain velocity less than -2 z score for age (2.3rd percentile); or (3) decline in weight, weight-for-length, or BMI greater than or equal to 1 z score. This definition was formulated by the guideline panel through an iterative process of discussion and voting to reach consensus. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to formulate recommendations and good practice statements, including GRADE Evidence-to-Decision frameworks, which were reviewed by internal and external contributors. The CPG provides 8 Key Action Statements (recommendations) and articulates 4 Good Practice Statements for additional guidance. Diagnostic testing is only recommended for children who have specific conditions that suggest a focal evaluation or persistent faltering weight. In children with persistent faltering weight or who have concerns for conditions that cannot be diagnosed without endoscopy, the CPG suggests endoscopy with biopsy. The CPG recommends the use of increased calories of food/energy; oral nutritional supplementation; and therapy for pediatric feeding disorder. When implemented, the CPG is intended to reduce confusion about diagnostic criteria and improve diagnostic accuracy, decrease overutilization of laboratory testing and imaging in children with faltering weight, and enhance health care utilization.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"189 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Socioeconomic Status and Different Treatment Modalities on Children With Faltering Weight: Technical Report.","authors":"Leena AlShenaiber,Emily Senerth,Ifeoluwa Babatunde,Kapeena Sivakumaran,Haya Waseem,Tiffany Yu,Abrar Alshorman,Reyad Al Jabiri,Qays Abu-Saymeh,Tejanth Pasumarthi,Lizbeth Hernandez Ronquillo,Anastas Kostojchin,Neha Tangri,Carrie B Daymont,Hans B Kersten,Reem Mustafa,Rebecca L Morgan","doi":"10.1542/peds.2026-076121","DOIUrl":"https://doi.org/10.1542/peds.2026-076121","url":null,"abstract":"BACKGROUNDLow socioeconomic status (SES) has been theorized to be a risk factor for faltering weight (previously \"failure to thrive\") in infants and children, but evidence is needed to understand the certainty of the association. Many treatment options exist with the aim of weight gain in infants and young children; however, the comparative effectiveness is not well understood.OBJECTIVEThis technical report assessed SES as a risk factor for faltering weight in children younger than 5 years who live in high-income countries and determined the comparative efficacy of available treatment options for children with faltering weight (eg, increased calories, supplementation, feeding/speech therapies). Feeding and speech therapies were almost always combined in the literature and were combined in this review.METHODSThe systematic review updates a previous review, from January 1, 2017 through June 27, 2022, for studies reporting on the relationship between SES and faltering growth on prevalence of faltering weight or thrive index (TI). To identify studies reporting on treatment options for faltering weight, reviewers searched PubMed, Embase, and Cochrane Library for comparative, English-language studies published from the database's inception through August 19, 2022. Eligible studies were conducted in high-income countries with at least 80% of the sample population younger than 5 years with suspected or diagnosed faltering weight. Data were extracted from studies and narratively summarized. Risk of bias was assessed by 2 researchers using the Prediction model of Risk of Bias Assessment Tool (PROBAST) tool, the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), and version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB 2). Certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach.FINDINGSOf 9111 records, the search identified 2 new cohort studies to update the body of evidence from the previous SES review. Of the 5 studies reporting on prevalence of faltering weight, 2 showed a U-shaped association between SES and prevalence of faltering weight, 1 study showed an inverse relationship, and the other 2 studies showed no association. The 2 studies that reported on mean TI also showed U-shaped association between TI and SES. Certainty of evidence was very low for all studies. Of 8959 records, 1 study investigated increasing calorie intake; 3 studies investigated supplementation; and 3 studies investigated feeding and speech therapies for the treatment of children with faltering weight. None of the interventions studied were associated with a meaningful increase in weight gain compared with usual care. There is very low certainty that increased caloric intake and supplementation led to more growth than usual care and low certainty that feeding and speech therapy supplementation led to more growth than usual care.CONCLUSIONS AND RELEVANCEThe results suggest t","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefits and Harms of Endoscopy and Other Diagnostic Tests to Detect Underlying Conditions in Children With Faltering Weight: Technical Report.","authors":"Ibrahim K El Mikati,Nadia I Ibrahimi,Abrar Alshorman,Kapeena Sivakumaran,Emily Senerth,Reyad Al Jabiri,Leena AlShenaiber,Ifeoluwa Babatunde,Anastas Kostojchin,Lori Krammer,Nicole R Palmer,Tejanth Pasumarthi,Lizbeth Hernandez Ronquillo,Neha Tangri,Haya Waseem,Tiffany Yu,Carrie B Daymont,Praveen S Goday,Rebecca L Morgan,Reem A Mustafa","doi":"10.1542/peds.2026-076120","DOIUrl":"https://doi.org/10.1542/peds.2026-076120","url":null,"abstract":"BACKGROUND AND OBJECTIVEFaltering weight (previously known as \"failure to thrive\") is a condition characterized by poor weight gain and has varied underlying etiologies that may require distinct diagnostic evaluations. This technical report describes systematic reviews to identify the benefits and harms of diagnostic tests, including endoscopy, in children younger than 5 years who live in high-income countries.METHODSTwo systematic reviews were conducted to assess the evidence regarding benefits and harms of diagnostic tests (including endoscopy) in these children. The search was conducted in electronic databases PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library up to September 27, 2022. Two review team members screened extracted data from potentially eligible articles independently and in duplicate. The Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach was used to assess the certainty (eg, quality) of evidence.RESULTSSix studies met inclusion criteria for the benefits and harms of a subset of diagnostic tests. The studies reported on the prevalence of underlying conditions; 2 of these studies also discussed test accuracy. Nine studies met inclusion criteria for evidence on the benefits and harms of endoscopy as a diagnostic tool. Seven studies discussed endoscopic diagnosis, 2 studies discussed histological findings, and 1 discussed procedural complications. The certainty in the evidence was very low because of concerns with risk of bias, inconsistency, and indirectness.CONCLUSIONSDiagnostic testing for underlying conditions in children who are suspected of having faltering weight should be performed at the clinician's discretion, on the basis of the child's condition, while considering tests' potential harms and costs. Future research is needed to better characterize the benefits and harms of evaluations in young children who are being assessed for faltering weight.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"54 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities and Alternative Approaches for Improving Language Outcomes in Young Children.","authors":"Heidi M Feldman,Virginia A Marchman","doi":"10.1542/peds.2025-075539","DOIUrl":"https://doi.org/10.1542/peds.2025-075539","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Utilization and Neighborhood Violence: 2019-2023.","authors":"Oluwatobi Emmanuel Adegbile,Oladipo Kunle Afolayan,Nnenna Ann Ukoha,Kiana Rachele Johnson","doi":"10.1542/peds.2025-071560","DOIUrl":"https://doi.org/10.1542/peds.2025-071560","url":null,"abstract":"BACKGROUND AND OBJECTIVESChildren experience the highest impact from neighborhood violence (NV) exposure. Timely access to care has proven to mitigate these untoward effects. However, robust, up-to-date information regarding patterns of health care access, including the impact of the COVID-19 pandemic among children exposed to NV, is lacking.METHODSWe used an annually collected nationally representative survey (National Health Interview Survey) to examine predictors of NV in 2019 to 2023. A residential parent or other adult knowledgeable about the child's health is selected to respond to questions about the child. We used a time series model to explore the impact of the COVID-19 pandemic on NV. We constructed logistic regression models to predict the patterns of health care access and use (preventive care access, acute care use, and unmet health needs) among children aged 2 to 17 years exposed to NV and adjusted for potential covariates.RESULTSOut of a sample of 29 013 representing a weighted population of 65 140 276 individuals, we found that 1676 children (weighted 3 735 352; 5.8% [95% CI, 5.5-6.2]) were exposed to NV from 2019 to 2023. The likelihood of exposure to NV increased significantly in 2022 compared with 2021. Exposure to NV is significantly associated with not having a routine dental examination, increased use of mental health services, increased acute care use, and delayed and forgone medical, dental, and mental health care due to cost.CONCLUSIONSAs challenges to prompt access to medical, dental, and mental health care persist among US children, exploring alternative strategies to pediatric health care financing is critical to robust childhood health care coverage.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}