Pub Date : 2026-03-16DOI: 10.1542/peds.2025-073409
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
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.
{"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}
Pub Date : 2026-03-16DOI: 10.1542/peds.2025-075764
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,
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.
{"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}
Pub Date : 2026-03-16DOI: 10.1542/peds.2026-076121
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
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
{"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}
Pub Date : 2026-03-16DOI: 10.1542/peds.2026-076120
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
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.
{"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}
Pub Date : 2026-03-16DOI: 10.1542/peds.2025-075539
Heidi M Feldman,Virginia A Marchman
{"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}
Pub Date : 2026-03-13DOI: 10.1542/peds.2025-071560
Oluwatobi Emmanuel Adegbile,Oladipo Kunle Afolayan,Nnenna Ann Ukoha,Kiana Rachele Johnson
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.
{"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}
Pub Date : 2026-03-13DOI: 10.1542/peds.2025-073730
Chiara Michienzie,John Galgiani,Sean P Fitzwater
OBJECTIVECoccidioidomycosis (CM) is not as well described in children as it is in adults. The Kaiser Permanente Southern California (KPSC) system provides care within an endemic region for CM, affording the opportunity to describe the diagnosis, management, and outcomes of CM in a large pediatric cohort.METHODSThis study is a retrospective manual medical record review of patients aged 17 years or younger with a new diagnosis of CM between January 1, 2015, and December 31, 2021. We extracted demographic characteristics, symptoms, diagnostic testing, and details of patient management.RESULTSCM was identified in 209 patients. The incidence was 3.3 cases per 100 000 children but varied within the area covered by KPSC. Common symptoms were fever, cough, and rash (>59% for each). Disseminated CM was present in 10 patients (4.8%). Of the 199 patients without disseminated infections, 57 were observed without antifungal treatment; 1 (1.2%) eventually required treatment. For the remaining 142 patients treated with antifungals, the median duration of treatment was 150 days (ranging from <3 months to >2 years). After stopping treatment, 3 (2.1%) had recurrence. Recurrence was identified primarily based on symptoms rather than serologic testing, and all responded well to treatment.CONCLUSIONSWide clinician variability in the management of pediatric coccidioidomycosis was observed. Recurrence after treatment or failure of observation without antifungals was rare. Results from serologic testing outside of the initial diagnosis in asymptomatic patients typically did not change clinical management, while symptomatic follow-up was important for management.
目的球孢子菌病（CM）在儿童中的描述不如成人。Kaiser Permanente Southern California （KPSC）系统在CM的流行地区提供护理，为描述CM的诊断、管理和结果提供了机会。方法：本研究是对2015年1月1日至2021年12月31日期间新诊断为CM的17岁及以下患者的回顾性手工病历回顾。我们提取了人口统计学特征、症状、诊断测试和患者管理细节。结果209例患者确诊为scm。发病率为每10万名儿童3.3例，但在KPSC覆盖的地区有所不同。常见症状为发热、咳嗽和皮疹（>.59%）。弥散性CM有10例（4.8%）。199例无播散性感染患者中，57例未接受抗真菌治疗；1例（1.2%）最终需要治疗。其余142例接受抗真菌药物治疗的患者，中位治疗时间为150天（2年不等）。停药后复发3例（2.1%）。复发主要是根据症状而不是血清学检测来确定的，所有患者对治疗反应良好。结论：小儿球孢子菌病的治疗存在广泛的临床差异。治疗后复发或未使用抗真菌药物观察失败的病例很少。在无症状患者的初始诊断之外的血清学检测结果通常不会改变临床管理，而有症状的随访对管理很重要。
{"title":"Variation in Management of Children With Coccidioidomycosis.","authors":"Chiara Michienzie,John Galgiani,Sean P Fitzwater","doi":"10.1542/peds.2025-073730","DOIUrl":"https://doi.org/10.1542/peds.2025-073730","url":null,"abstract":"OBJECTIVECoccidioidomycosis (CM) is not as well described in children as it is in adults. The Kaiser Permanente Southern California (KPSC) system provides care within an endemic region for CM, affording the opportunity to describe the diagnosis, management, and outcomes of CM in a large pediatric cohort.METHODSThis study is a retrospective manual medical record review of patients aged 17 years or younger with a new diagnosis of CM between January 1, 2015, and December 31, 2021. We extracted demographic characteristics, symptoms, diagnostic testing, and details of patient management.RESULTSCM was identified in 209 patients. The incidence was 3.3 cases per 100 000 children but varied within the area covered by KPSC. Common symptoms were fever, cough, and rash (>59% for each). Disseminated CM was present in 10 patients (4.8%). Of the 199 patients without disseminated infections, 57 were observed without antifungal treatment; 1 (1.2%) eventually required treatment. For the remaining 142 patients treated with antifungals, the median duration of treatment was 150 days (ranging from <3 months to >2 years). After stopping treatment, 3 (2.1%) had recurrence. Recurrence was identified primarily based on symptoms rather than serologic testing, and all responded well to treatment.CONCLUSIONSWide clinician variability in the management of pediatric coccidioidomycosis was observed. Recurrence after treatment or failure of observation without antifungals was rare. Results from serologic testing outside of the initial diagnosis in asymptomatic patients typically did not change clinical management, while symptomatic follow-up was important for management.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439305","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}
Pub Date : 2026-03-12DOI: 10.1542/peds.2025-075442
Maria Trent
{"title":"The 2025 David G. Nichols Health Equity Award Address: Leaning into Our Power to Achieve Health Equity for Children, Adolescents, and Young Adults.","authors":"Maria Trent","doi":"10.1542/peds.2025-075442","DOIUrl":"https://doi.org/10.1542/peds.2025-075442","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393900","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}
Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disorder with rare but potentially fatal respiratory complications. We present an exceptional documented case of TEN with severe bronchial obstruction successfully treated with tocilizumab and ruxolitinib in an 11-year-old patient. Despite early methylprednisolone pulse therapy, a repeat bronchoscopy showed progressive obstruction of proximal bronchial lumen by synechiae and mucosal membranes. Following multidisciplinary discussion, treatment was intensified with tocilizumab and ruxolitinib, resulting in marked respiratory improvement and decreased proinflammatory cytokines in bronchoalveolar lavage. No adverse effects were observed during 8 months of follow-up. Recent research supports Janus kinase inhibitors as targeted therapy in TEN.
{"title":"Ruxolitinib and Tocilizumab for Child Bronchiolitis Obliterans After Toxic Epidermal Necrolysis.","authors":"Léa Jaume,Sophie Schmartz,Anne Welfringer-Morin,Christophe Delacourt,Maria Leite-de-Moraes,David Drummond,Christine Bodemer","doi":"10.1542/peds.2025-073162","DOIUrl":"https://doi.org/10.1542/peds.2025-073162","url":null,"abstract":"Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disorder with rare but potentially fatal respiratory complications. We present an exceptional documented case of TEN with severe bronchial obstruction successfully treated with tocilizumab and ruxolitinib in an 11-year-old patient. Despite early methylprednisolone pulse therapy, a repeat bronchoscopy showed progressive obstruction of proximal bronchial lumen by synechiae and mucosal membranes. Following multidisciplinary discussion, treatment was intensified with tocilizumab and ruxolitinib, resulting in marked respiratory improvement and decreased proinflammatory cytokines in bronchoalveolar lavage. No adverse effects were observed during 8 months of follow-up. Recent research supports Janus kinase inhibitors as targeted therapy in TEN.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"31 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393994","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}
Pub Date : 2026-03-11DOI: 10.1542/peds.2025-074603
Julia Buchmayer,Sophie Stummer,Renate Fuiko,Gregor Kasprian,Katrin Klebermaß-Schrehof,Angelika Berger,Katharina Goeral
BACKGROUND AND OBJECTIVESCerebellar pathologies, especially cerebellar hemorrhage (CBH), in extremely preterm infants has been increasingly detected through cerebral magnetic resonance imaging (cMRI). We evaluated prevalence, associated risk factors, and neurodevelopmental outcomes of isolated CBH in a contemporary cohort of high-risk infants without major supratentorial brain injuries.METHODSThis observational cohort study included infants born at less than 28 weeks' gestation during 2017-2022 who underwent cMRI at term-equivalent age. Cerebellar pathologies, including low-grade (≤3 mm) and high-grade (>3 mm) hemorrhages, cerebellar atrophy, and vermis hemorrhage, and their impact on outcomes at 2 years' corrected age were analyzed using multivariable regression adjusted for relevant neurodevelopmental covariates. Risk factors for CBH were also examined.RESULTSCBH was identified in 69 of 252 infants without major supratentorial injuries (27.4%; 74% low-grade and 26% high-grade injuries). At 2 years' corrected age, motor composite scores were significantly lower in the CBH group, including low-grade hemorrhage (≤3 mm). Larger hemorrhages and cerebellar atrophy were associated with poorer cognitive and motor performance. Vermian hemorrhages were linked to impaired motor development and higher rates of cerebral palsy. Infants with isolated CBH had lower gestational ages, birth weights, and 1-minute Apgar scores and higher rates of sepsis, patent ductus arteriosus requiring intervention, and high-grade retinopathy of prematurity.CONCLUSIONSExtremely preterm infants without supratentorial brain injury with CBH on cMRI demonstrated significantly impaired motor outcomes and higher rates of cerebral palsy at 2 years' corrected age. These findings highlight isolated CBH as an independent risk factor for neurodevelopmental impairment and for refining prognostication.
{"title":"Neurodevelopmental Outcomes of Isolated Cerebellar Pathologies in Extremely Preterm Infants.","authors":"Julia Buchmayer,Sophie Stummer,Renate Fuiko,Gregor Kasprian,Katrin Klebermaß-Schrehof,Angelika Berger,Katharina Goeral","doi":"10.1542/peds.2025-074603","DOIUrl":"https://doi.org/10.1542/peds.2025-074603","url":null,"abstract":"BACKGROUND AND OBJECTIVESCerebellar pathologies, especially cerebellar hemorrhage (CBH), in extremely preterm infants has been increasingly detected through cerebral magnetic resonance imaging (cMRI). We evaluated prevalence, associated risk factors, and neurodevelopmental outcomes of isolated CBH in a contemporary cohort of high-risk infants without major supratentorial brain injuries.METHODSThis observational cohort study included infants born at less than 28 weeks' gestation during 2017-2022 who underwent cMRI at term-equivalent age. Cerebellar pathologies, including low-grade (≤3 mm) and high-grade (>3 mm) hemorrhages, cerebellar atrophy, and vermis hemorrhage, and their impact on outcomes at 2 years' corrected age were analyzed using multivariable regression adjusted for relevant neurodevelopmental covariates. Risk factors for CBH were also examined.RESULTSCBH was identified in 69 of 252 infants without major supratentorial injuries (27.4%; 74% low-grade and 26% high-grade injuries). At 2 years' corrected age, motor composite scores were significantly lower in the CBH group, including low-grade hemorrhage (≤3 mm). Larger hemorrhages and cerebellar atrophy were associated with poorer cognitive and motor performance. Vermian hemorrhages were linked to impaired motor development and higher rates of cerebral palsy. Infants with isolated CBH had lower gestational ages, birth weights, and 1-minute Apgar scores and higher rates of sepsis, patent ductus arteriosus requiring intervention, and high-grade retinopathy of prematurity.CONCLUSIONSExtremely preterm infants without supratentorial brain injury with CBH on cMRI demonstrated significantly impaired motor outcomes and higher rates of cerebral palsy at 2 years' corrected age. These findings highlight isolated CBH as an independent risk factor for neurodevelopmental impairment and for refining prognostication.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"6 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383706","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}
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