Journal of Pediatrics最新文献

Objective: This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis infleunces treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD).

Study design: This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n=631,295). Youth with ADHD+DMDD (n=24,723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations.

Results: Compared with controls, ADHD+DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD+DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD+DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants.

Conclusions: In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.

Objective: To examine pediatrician diagnostic skill development of dermatology image-based cases via a web-based tool and to determine case-level variables that were associated with diagnostic error.

Study design: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatric trainees and attendees were eligible for participation. Using a web-based tool, physicians practiced 334 pediatric dermatology image-based cases until they achieved a performance standard. Participants identified whether the case was concerning, the morphologic category, and the specific diagnosis. After every case, participants received corrective feedback and their progress toward the performance standard.

Results: Among 185 participants, there was a significant improvement in diagnostic performance in classifying concerning vs nonconcerning (+19.2% [95% CI 17.7, 20.6]), morphologic category (+17.9% [95% CI 16.5, 19.3]), and specific diagnosis (+25.2% [95% CI 23.4, 26.7]). The median number of cases required to achieve the performance standard was 142 (IQR 96, 209; min 58, max 330), with a median time to achievement of 57.3 minutes (IQR 38.7, 84.3). Based on 38 502 case interpretations, children with darker vs lighter skin color had a lower odds of correct identification of "concerning" (OR = 0.87; 95% CI 0.83, 0.93), morphologic category (OR = 0.91; 95% CI 0.85, 0.97), and specific disease (OR = 0.96; 95% CI 0.90; 0.99). Fewer than 60% of participants correctly identified bullous variations of diseases, psoriasis, herpes infections, and nonspecific viral infections.

Conclusions: The deliberate practice of dermatologic presentations in the context of an education intervention significantly and efficiently improved pediatrician diagnostic ability. The specific diagnostic challenges identified also provide opportunity for targeted learning opportunities in these areas.

Objective: To examine prospectively the relationship between teething and infant sleep using objective sleep measurements.

Study design: Over a 4-week period, 849 infants aged 3-18 months (mean = 8.4 ± 1.8) from the US and Canada were monitored using auto-videosomnography, based on computer-vision technology to decode video footage from crib camera monitors. Parents also provided reports of tooth eruption timing, symptoms, and management strategies. Objective sleep metrics, including total sleep time, nighttime awakenings, and parental crib visits, were compared between teething and non-teething nights using generalized estimating equations and changepoint analysis.

Results: Both analytic approaches showed no significant differences in sleep metrics between teething and non-teething nights. Although over half the parents reported sleep disturbances during teething, these subjective reports were not corroborated by the objective data.

Conclusions: These findings challenge the widely held belief that teething disrupts sleep and highlight the need for pediatric healthcare professionals to consider alternative explanations for infant sleep problems. Educating parents with evidence-based information may prevent potentially harmful management strategies for teething (eg, excessive use of analgesics and local anesthetics) and improve sleep problem management. Future research should explore these relationships using multiple objective measures and more diverse populations.