Pub Date : 2026-03-11DOI: 10.1542/peds.2025-074710
Grant L Lin, Sarah Jean Barton, Tyler Tate
{"title":"Addressing Disability Bias in Neuroprognostication.","authors":"Grant L Lin, Sarah Jean Barton, Tyler Tate","doi":"10.1542/peds.2025-074710","DOIUrl":"https://doi.org/10.1542/peds.2025-074710","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434647","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}
The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.
{"title":"Life After Death: Ethical Considerations of CPR in Brain-Dead Pediatric Organ Donors.","authors":"Jenny Kingsley,Miriam Piven Cotler,Brenda Barnum,Amy Shimada,Kailey Anber,Sabrina Derrington","doi":"10.1542/peds.2025-072297","DOIUrl":"https://doi.org/10.1542/peds.2025-072297","url":null,"abstract":"The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381375","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 : 2026-03-10DOI: 10.1542/peds.2025-071434
Sara E Bibbens,Jonathan D Stallings,Monica L Casmaer,Margaret M Shields,Michael J Clarion,Patrick W Hickey,Jennifer M Gurney
OBJECTIVEPediatric mortality from conflict-related injuries exceeds that of adults. Understanding pediatric injury patterns and outcomes is critical for guiding resource allocation and training. This study characterizes pediatric injuries in conflict zones and examines relationships between injury patterns, resource allocation, and survival.METHODSA retrospective cohort analysis of the Department of Defense Trauma Registry from 2001 to 2022 was conducted for children younger than 18 years treated at deployed military treatment facilities in conflict zones with documented injuries and discharge status. The primary outcome was survival to hospital discharge.RESULTSA total of 5695 children met inclusion criteria with an overall mortality rate of 9.4%. Nonsurvivors had higher injury severity scores (25 vs 9, P < .001), were younger, and sustained burn injuries (18.1% vs 9.4%, P < .001). They experienced greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, P < .001) and required more transfusions (47.9% vs 29.4% P < .001). Neither group received balanced transfusion, with packed red blood cell-to-platelet ratios of 4:1 in nonsurvivors and 6.5:1 in survivors.CONCLUSIONThis large epidemiologic study highlights age-specific injury patterns and resuscitation needs contributing to pediatric mortality in conflict zones. Higher blood loss and resuscitation volumes in nonsurvivors underscore the need for early hemorrhage control. Findings support strategies that include standardized pediatric equipment and targeted training in early recognition and management of hemorrhagic shock with balanced transfusion. These results emphasize the need for tailored resources and protocols for pediatric patients in austere, conflict-related settings.
目的：冲突相关伤害的儿童死亡率超过成人。了解儿童损伤模式和结果对于指导资源分配和培训至关重要。本研究分析了冲突地区的儿科损伤特征，并探讨了损伤模式、资源分配和生存之间的关系。方法对2001年至2022年在冲突地区部署的军事治疗设施接受治疗的18岁以下儿童进行回顾性队列分析，并记录受伤和出院情况。主要终点是存活至出院。结果5695名儿童符合纳入标准，总死亡率为9.4%。非幸存者的损伤严重程度评分更高(25比9，P <。0.001)，年轻，持续烧伤（18.1% vs 9.4%, P < 0.001）。他们的中位[IQR]出血量更大(12.1 [3.6,24.8]mL/kg vs 2.9 [1.2, 8.3] mL/kg, P <。（47.9% vs 29.4% P < 0.001）。两组均接受平衡输血，未存活者红细胞与血小板的比例为4:1，存活者为6.5:1。结论：这项大型流行病学研究强调了冲突地区儿童死亡率的年龄特异性损伤模式和复苏需求。失血量和复苏量的增加强调了早期出血控制的必要性。研究结果支持的策略包括标准化儿科设备和有针对性的培训，早期识别和管理失血性休克平衡输血。这些结果强调了在严峻的冲突相关环境中为儿科患者量身定制资源和方案的必要性。
{"title":"Pediatric Mortality in Deployed United States Military Treatment Facilities: 2001-2022.","authors":"Sara E Bibbens,Jonathan D Stallings,Monica L Casmaer,Margaret M Shields,Michael J Clarion,Patrick W Hickey,Jennifer M Gurney","doi":"10.1542/peds.2025-071434","DOIUrl":"https://doi.org/10.1542/peds.2025-071434","url":null,"abstract":"OBJECTIVEPediatric mortality from conflict-related injuries exceeds that of adults. Understanding pediatric injury patterns and outcomes is critical for guiding resource allocation and training. This study characterizes pediatric injuries in conflict zones and examines relationships between injury patterns, resource allocation, and survival.METHODSA retrospective cohort analysis of the Department of Defense Trauma Registry from 2001 to 2022 was conducted for children younger than 18 years treated at deployed military treatment facilities in conflict zones with documented injuries and discharge status. The primary outcome was survival to hospital discharge.RESULTSA total of 5695 children met inclusion criteria with an overall mortality rate of 9.4%. Nonsurvivors had higher injury severity scores (25 vs 9, P < .001), were younger, and sustained burn injuries (18.1% vs 9.4%, P < .001). They experienced greater median [IQR] blood loss (12.1 [3.6, 24.8] mL/kg vs 2.9 [1.2, 8.3] mL/kg, P < .001) and required more transfusions (47.9% vs 29.4% P < .001). Neither group received balanced transfusion, with packed red blood cell-to-platelet ratios of 4:1 in nonsurvivors and 6.5:1 in survivors.CONCLUSIONThis large epidemiologic study highlights age-specific injury patterns and resuscitation needs contributing to pediatric mortality in conflict zones. Higher blood loss and resuscitation volumes in nonsurvivors underscore the need for early hemorrhage control. Findings support strategies that include standardized pediatric equipment and targeted training in early recognition and management of hemorrhagic shock with balanced transfusion. These results emphasize the need for tailored resources and protocols for pediatric patients in austere, conflict-related settings.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"63 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381374","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 : 2026-03-09DOI: 10.1542/peds.2025-070970
James P Guevara,Marsha Gerdes,Ellie Segan,Katherine Yun,Kate Wallis,Jeannette Newman,Roy Wade,Sara Molina-Robinson,Jungwon Min,Knashawn H Morales
OBJECTIVEDisparities in early intervention (EI) use are well documented. We sought to determine the effects of family navigation (FN) on EI services use and child development among low-income, racially diverse children with suspected developmental delays.METHODSWe conducted a randomized controlled trial at 6 pediatric practices in a large urban community. Children who were aged younger than 30 months, had a gestational age of more than 35 weeks, had parents who spoke English or Spanish, and were referred to Part C EI were eligible. Children were randomized to FN or usual care and followed for 12 months. The main outcome measures were multidisciplinary evaluation (MDE) and EI service initiation and duration obtained from county EI program administrative files and Bayley-3 developmental scores. We examined differences among groups using intention-to-treat logistic and Cox regression models.RESULTSWe randomized 358 eligible children and followed 305 (85%) for 12 months. Children were predominantly Black with family incomes of less than $55 000. Overall, 257 (72%) completed an MDE, and 195 (54%) initiated services. Children who received FN had greater odds of MDE completion (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) and greater EI service initiation (64.4% vs 54.7%; P = .02) than children who received usual care. The average duration of EI services and Bayley-3 scores did not differ among groups.CONCLUSIONSWe found that an FN program improved EI referral completion and services initiation but not EI duration or child development among a population of predominantly low-income urban Black children. Implementation of FN programs in similar minoritized communities may reduce disparities in access to EI services.
目的早期干预（EI）使用的差异有很好的文献记载。我们试图确定家庭导航（FN）对EI服务使用和儿童发展的影响，这些影响来自低收入、不同种族、疑似发育迟缓的儿童。方法我们在一个大型城市社区的6个儿科诊所进行了一项随机对照试验。年龄小于30个月，胎龄大于35周，父母说英语或西班牙语，并且被转介到C部分EI的儿童符合条件。儿童随机分为FN组和常规组，随访12个月。主要结局指标为多学科评价（MDE）、EI服务启动和持续时间（来自县EI项目管理文件）和Bayley-3发展评分。我们使用意向治疗逻辑模型和Cox回归模型检验各组之间的差异。结果我们随机抽取358名符合条件的儿童，随访305名（85%），随访12个月。儿童以黑人为主，家庭收入低于5.5万美元。总体而言，257人（72%）完成了MDE， 195人（54%）启动了服务。接受FN治疗的儿童完成MDE的几率更高（调整后的优势比为2.1；95% CI为1.2-3.5），更大的EI服务开始(64.4% vs 54.7%; P =。02)比接受常规护理的儿童多。EI服务的平均持续时间和Bayley-3评分在组间无差异。结论：我们发现FN项目改善了主要是低收入城市黑人儿童的EI转诊完成和服务启动，但没有改善EI持续时间或儿童发育。在类似的少数族裔社区实施FN项目可以减少获得EI服务方面的差距。
{"title":"Family Navigation to Reduce Disparities in Early Intervention Services: A Randomized Controlled Trial.","authors":"James P Guevara,Marsha Gerdes,Ellie Segan,Katherine Yun,Kate Wallis,Jeannette Newman,Roy Wade,Sara Molina-Robinson,Jungwon Min,Knashawn H Morales","doi":"10.1542/peds.2025-070970","DOIUrl":"https://doi.org/10.1542/peds.2025-070970","url":null,"abstract":"OBJECTIVEDisparities in early intervention (EI) use are well documented. We sought to determine the effects of family navigation (FN) on EI services use and child development among low-income, racially diverse children with suspected developmental delays.METHODSWe conducted a randomized controlled trial at 6 pediatric practices in a large urban community. Children who were aged younger than 30 months, had a gestational age of more than 35 weeks, had parents who spoke English or Spanish, and were referred to Part C EI were eligible. Children were randomized to FN or usual care and followed for 12 months. The main outcome measures were multidisciplinary evaluation (MDE) and EI service initiation and duration obtained from county EI program administrative files and Bayley-3 developmental scores. We examined differences among groups using intention-to-treat logistic and Cox regression models.RESULTSWe randomized 358 eligible children and followed 305 (85%) for 12 months. Children were predominantly Black with family incomes of less than $55 000. Overall, 257 (72%) completed an MDE, and 195 (54%) initiated services. Children who received FN had greater odds of MDE completion (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) and greater EI service initiation (64.4% vs 54.7%; P = .02) than children who received usual care. The average duration of EI services and Bayley-3 scores did not differ among groups.CONCLUSIONSWe found that an FN program improved EI referral completion and services initiation but not EI duration or child development among a population of predominantly low-income urban Black children. Implementation of FN programs in similar minoritized communities may reduce disparities in access to EI services.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"40 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374180","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 : 2026-03-09DOI: 10.1542/peds.2025-073470
Donald B Bailey
{"title":"Supporting Family Engagement in Early Intervention.","authors":"Donald B Bailey","doi":"10.1542/peds.2025-073470","DOIUrl":"https://doi.org/10.1542/peds.2025-073470","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374129","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 : 2026-03-06DOI: 10.1542/peds.2025-070887
Hung Ho,April Slamowitz,Cyrus E Kuschner,Jessica Gold,Sharon Dial,Kaytlin Krutsch,Joshua Nogar
Hypoglycin A is a mitochondrial toxin found in unripe soapberry fruits such as ackee. This toxin disrupts fatty acid β-oxidation, leading to severe metabolic derangements. Although toxic exposure through ingestion has been well documented, transfer through human milk is not well characterized. We report a full-term, exclusively breastfed 5-month-old infant, a carrier of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, who developed profound hypoketotic hypoglycemia, metabolic and respiratory acidosis, and vasoactive-refractory shock 2 days after maternal ingestion of unripe ackee fruit. Despite aggressive management, including fluids, dextrose infusion, levocarnitine, and empirical antibiotics, the infant developed ventricular dysrhythmias and cardiac arrest. He required venoarterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support. Metabolic evaluation showed impaired β-oxidation on acylcarnitine profile. Hypoglycin A was detected in breast milk, with concentrations decreasing over time following maternal ingestion. Genetic testing confirmed MCAD carrier status with 2 maternally inherited ACADM variants in cis. The patient was decannulated from VA-ECMO on hospital day 4 and discharged with normal neurological function. This case illustrates a "2-hit" model of toxicity, in which genetic vulnerability to impaired fatty acid oxidation compounded the effects of a mitochondrial toxin. It represents a rare and clinically significant instance of hypoglycin A toxicity transmitted via human breast milk and includes the use of extracorporeal life support for hypoglycin A-related metabolic collapse in a human. Clinicians must maintain a high index of suspicion for hypoglycin A exposure in critically ill, breastfed infants and proactively counsel lactating individuals to avoid consumption of unripe ackee fruit to prevent potentially fatal outcomes.
{"title":"Case of Infant With Metabolic Crisis From Lactational Hypoglycin A and Fatty Acid Defect.","authors":"Hung Ho,April Slamowitz,Cyrus E Kuschner,Jessica Gold,Sharon Dial,Kaytlin Krutsch,Joshua Nogar","doi":"10.1542/peds.2025-070887","DOIUrl":"https://doi.org/10.1542/peds.2025-070887","url":null,"abstract":"Hypoglycin A is a mitochondrial toxin found in unripe soapberry fruits such as ackee. This toxin disrupts fatty acid β-oxidation, leading to severe metabolic derangements. Although toxic exposure through ingestion has been well documented, transfer through human milk is not well characterized. We report a full-term, exclusively breastfed 5-month-old infant, a carrier of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, who developed profound hypoketotic hypoglycemia, metabolic and respiratory acidosis, and vasoactive-refractory shock 2 days after maternal ingestion of unripe ackee fruit. Despite aggressive management, including fluids, dextrose infusion, levocarnitine, and empirical antibiotics, the infant developed ventricular dysrhythmias and cardiac arrest. He required venoarterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support. Metabolic evaluation showed impaired β-oxidation on acylcarnitine profile. Hypoglycin A was detected in breast milk, with concentrations decreasing over time following maternal ingestion. Genetic testing confirmed MCAD carrier status with 2 maternally inherited ACADM variants in cis. The patient was decannulated from VA-ECMO on hospital day 4 and discharged with normal neurological function. This case illustrates a \"2-hit\" model of toxicity, in which genetic vulnerability to impaired fatty acid oxidation compounded the effects of a mitochondrial toxin. It represents a rare and clinically significant instance of hypoglycin A toxicity transmitted via human breast milk and includes the use of extracorporeal life support for hypoglycin A-related metabolic collapse in a human. Clinicians must maintain a high index of suspicion for hypoglycin A exposure in critically ill, breastfed infants and proactively counsel lactating individuals to avoid consumption of unripe ackee fruit to prevent potentially fatal outcomes.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"70 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359279","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 : 2026-03-06DOI: 10.1542/peds.2025-072230
Nia Fogelman,Heather Bernstein,Tara Bautista,Mary Savoye,Tara M Chaplin,Wendy K Silverman,Ania M Jastreboff,Rajita Sinha
OBJECTIVETo assess whether a novel parent stress with nutrition vs nutrition alone intervention decreases early childhood obesity risk.METHODSA prospective, parallel, 12-week randomized controlled trial with parents who were overweight (114 dyads body mass index [BMI]: 34.7 ± 6.6) and their young children (aged 2-5 years) was conducted between November 2018 and July 2022. Parenting Mindfully for Health (PMH+N) was compared with the control (CTL+N) weekly group intervention, each with nutrition and physical activity (N) psychoeducation. Changes in child BMI and parent stress were coprimary outcomes, whereas observed parenting in an established laboratory-based parent-child Toy-Wait Task (TWT) and child food intake were secondary outcomes.RESULTSChild BMI z score significantly increased by 0.41 ([0.13, 0.69], P < .005) in the CTL+N, but PMH+N remained unchanged (0.20 [-0.49, 0.09], P > .17) over the 3-month follow-up, and parent stress decreased (3.17 [-5.19, -1.15] points, P < .003) only in the PMH+N arm. Significant time main effects indicated increased TWT positive parenting (2.82 [1.24, 4.4], P < .001) and reduced unhealthy child food intake (-1.78 [-3.02, -0.54]), driven by the PMH+N arm (P values <.02). Parent stress interacted with PMH+N vs CTL+N intervention to predict lower TWT positive parenting and child healthy food intake in the CTL+N arm (-1.74 [-3.26, -0.22] and -3.41 [-7.25, 0.42], respectively).CONCLUSIONSTargeting parent stress with healthy nutrition is effective in preventing short-term early childhood obesity risk and in improving positive parenting and child healthy food intake. Further assessment of long-term effects of the PMH+N intervention on early childhood risk is warranted. (Clinical Trials Registration: NCT03950453).
{"title":"Mindfulness Intervention for Parent Stress and Childhood Obesity Risk: A Randomized Trial.","authors":"Nia Fogelman,Heather Bernstein,Tara Bautista,Mary Savoye,Tara M Chaplin,Wendy K Silverman,Ania M Jastreboff,Rajita Sinha","doi":"10.1542/peds.2025-072230","DOIUrl":"https://doi.org/10.1542/peds.2025-072230","url":null,"abstract":"OBJECTIVETo assess whether a novel parent stress with nutrition vs nutrition alone intervention decreases early childhood obesity risk.METHODSA prospective, parallel, 12-week randomized controlled trial with parents who were overweight (114 dyads body mass index [BMI]: 34.7 ± 6.6) and their young children (aged 2-5 years) was conducted between November 2018 and July 2022. Parenting Mindfully for Health (PMH+N) was compared with the control (CTL+N) weekly group intervention, each with nutrition and physical activity (N) psychoeducation. Changes in child BMI and parent stress were coprimary outcomes, whereas observed parenting in an established laboratory-based parent-child Toy-Wait Task (TWT) and child food intake were secondary outcomes.RESULTSChild BMI z score significantly increased by 0.41 ([0.13, 0.69], P < .005) in the CTL+N, but PMH+N remained unchanged (0.20 [-0.49, 0.09], P > .17) over the 3-month follow-up, and parent stress decreased (3.17 [-5.19, -1.15] points, P < .003) only in the PMH+N arm. Significant time main effects indicated increased TWT positive parenting (2.82 [1.24, 4.4], P < .001) and reduced unhealthy child food intake (-1.78 [-3.02, -0.54]), driven by the PMH+N arm (P values <.02). Parent stress interacted with PMH+N vs CTL+N intervention to predict lower TWT positive parenting and child healthy food intake in the CTL+N arm (-1.74 [-3.26, -0.22] and -3.41 [-7.25, 0.42], respectively).CONCLUSIONSTargeting parent stress with healthy nutrition is effective in preventing short-term early childhood obesity risk and in improving positive parenting and child healthy food intake. Further assessment of long-term effects of the PMH+N intervention on early childhood risk is warranted. (Clinical Trials Registration: NCT03950453).","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"21 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359367","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 : 2026-03-05DOI: 10.1542/peds.2025-071429
Dillon Prus
{"title":"Michigan's Crusade for Clean Hands: The Modern Health Crusade Revisited.","authors":"Dillon Prus","doi":"10.1542/peds.2025-071429","DOIUrl":"https://doi.org/10.1542/peds.2025-071429","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"68 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350807","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 : 2026-03-05DOI: 10.1542/peds.2025-074493
Noelle G Moreau,Kristie F Bjornson,Phil Hurvitz,Donald E Mercante
OBJECTIVESDetermine the effect of lower-extremity power training combined with interval treadmill training (PT3) on walking capacity and performance in children with cerebral palsy (CP).METHODSIn this multisite, single-blinded randomized clinical trial, children with spastic, bilateral CP between ages 10 and 17 years were randomized to receive 24 sessions of either PT3 or traditional strength training combined with steady-state treadmill training (STT). Primary outcomes were normalized self-selected and fast gait speed and muscle power. Participants were assessed at baseline, immediate postintervention, 2-month post, and 6-month post.RESULTSOf 43 recruited participants (20 female participants; mean age 13.1 SD 2.2 years for PT3 group; mean age 13.8 SD 2.6 years for STT group), 38 were included in the final analyses. No differences between groups were observed for self-selected speed. PT3 had significantly greater change in fast speed from baseline to 2-month post compared with STT (adjusted mean difference [MD], 0.030; 95% CI, 0.002-0.059; P = .04). Change in muscle power from baseline to immediate post was significantly greater in the PT3 group (MD, 52.01; 95% CI, 5.63-98.39; P = .03). Stride rate intensity increased immediate post after PT3 (MD, 7.95; 95% CI, 0.45-15.95; P = .04).CONCLUSIONSPower training combined with high-intensity interval treadmill training was superior to an equivalent dosage of traditional strength training combined with steady-state treadmill training for improving muscle power immediate post-training and fast gait speed 2-month post-training. Increases in stride rate intensity after PT3 were not maintained at follow-up time points.
目的探讨下肢力量训练联合间歇跑步机训练（PT3）对脑瘫（CP）患儿行走能力和运动表现的影响。方法在这项多中心、单盲随机临床试验中，年龄在10 - 17岁之间的痉挛性双侧CP儿童随机接受24次PT3或传统力量训练结合稳态跑步机训练（STT）。主要结果是标准化的自我选择和快速的步态速度和肌肉力量。在基线、干预后立即、干预后2个月和干预后6个月对参与者进行评估。结果招募的43名参与者（20名女性参与者，PT3组平均年龄13.1 SD 2.2岁，STT组平均年龄13.8 SD 2.6岁）中有38人被纳入最终分析。自选速度组间无差异。与STT相比，PT3从基线到2个月后的快速变化明显更大（调整后的平均差[MD]， 0.030; 95% CI, 0.002-0.059; P = 0.04）。PT3组肌肉力量从基线到术后即刻的变化明显更大（MD, 52.01; 95% CI, 5.63-98.39; P = .03）。PT3后步频强度立即增加（MD, 7.95; 95% CI, 0.45-15.95; P = 0.04）。结论力量训练联合高强度间歇跑步机训练在提高训练后即刻肌肉力量和训练后2个月快速步态速度方面优于同等剂量的传统力量训练联合稳态跑步机训练。PT3后步幅强度的增加在随访时间点未保持。
{"title":"Power Training Combined With Interval Treadmill Training in Cerebral Palsy: An RCT.","authors":"Noelle G Moreau,Kristie F Bjornson,Phil Hurvitz,Donald E Mercante","doi":"10.1542/peds.2025-074493","DOIUrl":"https://doi.org/10.1542/peds.2025-074493","url":null,"abstract":"OBJECTIVESDetermine the effect of lower-extremity power training combined with interval treadmill training (PT3) on walking capacity and performance in children with cerebral palsy (CP).METHODSIn this multisite, single-blinded randomized clinical trial, children with spastic, bilateral CP between ages 10 and 17 years were randomized to receive 24 sessions of either PT3 or traditional strength training combined with steady-state treadmill training (STT). Primary outcomes were normalized self-selected and fast gait speed and muscle power. Participants were assessed at baseline, immediate postintervention, 2-month post, and 6-month post.RESULTSOf 43 recruited participants (20 female participants; mean age 13.1 SD 2.2 years for PT3 group; mean age 13.8 SD 2.6 years for STT group), 38 were included in the final analyses. No differences between groups were observed for self-selected speed. PT3 had significantly greater change in fast speed from baseline to 2-month post compared with STT (adjusted mean difference [MD], 0.030; 95% CI, 0.002-0.059; P = .04). Change in muscle power from baseline to immediate post was significantly greater in the PT3 group (MD, 52.01; 95% CI, 5.63-98.39; P = .03). Stride rate intensity increased immediate post after PT3 (MD, 7.95; 95% CI, 0.45-15.95; P = .04).CONCLUSIONSPower training combined with high-intensity interval treadmill training was superior to an equivalent dosage of traditional strength training combined with steady-state treadmill training for improving muscle power immediate post-training and fast gait speed 2-month post-training. Increases in stride rate intensity after PT3 were not maintained at follow-up time points.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"403 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350607","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 : 2026-03-04DOI: 10.1542/peds.2025-074912
Robert W Grundmeier,Alexander G Fiks,Brian P Jenssen,Stephon N Proctor,Daria F Ferro,Kevin B Johnson,
Generative artificial intelligence (AI) technologies, capable of producing original text, images, audio, and video, are increasingly embedded in children's learning, play, and daily life. Pediatric clinicians and parents face the challenge of guiding children toward safe and constructive engagement with these rapidly evolving tools. This state-of-the-art review synthesizes current knowledge regarding opportunities, risks, and best practices related to children's interactions with generative AI. Developmental considerations are emphasized because the impact of AI varies across early childhood, middle childhood, and adolescence. We highlight potential benefits, including personalized learning, creative expression, and enhanced communication, while also discussing risks such as misinformation, privacy threats, and false perceptions of AI as a friend or caregiver. Evidence-based strategies are proposed to promote AI literacy, critical thinking, and safe integration of AI into pediatric care and education.
{"title":"Generative Artificial Intelligence: Implications for Families and Pediatricians.","authors":"Robert W Grundmeier,Alexander G Fiks,Brian P Jenssen,Stephon N Proctor,Daria F Ferro,Kevin B Johnson, ","doi":"10.1542/peds.2025-074912","DOIUrl":"https://doi.org/10.1542/peds.2025-074912","url":null,"abstract":"Generative artificial intelligence (AI) technologies, capable of producing original text, images, audio, and video, are increasingly embedded in children's learning, play, and daily life. Pediatric clinicians and parents face the challenge of guiding children toward safe and constructive engagement with these rapidly evolving tools. This state-of-the-art review synthesizes current knowledge regarding opportunities, risks, and best practices related to children's interactions with generative AI. Developmental considerations are emphasized because the impact of AI varies across early childhood, middle childhood, and adolescence. We highlight potential benefits, including personalized learning, creative expression, and enhanced communication, while also discussing risks such as misinformation, privacy threats, and false perceptions of AI as a friend or caregiver. Evidence-based strategies are proposed to promote AI literacy, critical thinking, and safe integration of AI into pediatric care and education.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346409","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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