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In This Issue of JAMA Pediatrics
September 2013


JAMA Pediatr. 2013;167(9):785. doi:10.1001/jamapediatrics.2013.3271

Beyerlein and colleagues examined whether early, short-term, or cumulative exposures to episodes of infection and fever during the first 3 years of life were associated with the initiation of persistent islet autoimmunity in children at increased risk for type 1 diabetes mellitus. They studied 1245 infectious events in 148 children over the first 3 years of life. The risk for islet autoantibody seroconversion was more than doubled by a respiratory infection in the first 6 months of life, demonstrating that such infections are an important risk factor for the development of diabetes.

Music has been found to decrease the need for sedation in adult intensive care unit patients. Hartling and colleagues compared music with standard care to manage pain and distress in a randomized trial with 42 children aged 3 to 11 years undergoing intravenous placement in a pediatric emergency department. Music was found to decrease distress, lower pain, and improve satisfaction among parents and health care providers.

Continuing Medical Education, Journal Club

To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later cognition, Belfort and colleagues followed up 1312 Project Viva mothers and children to age 7 years. Longer duration of breastfeeding and greater exclusivity of breastfeeding were associated with better receptive language at age 3 years and with higher verbal and nonverbal IQ at age 7 years. An editorial by Dimitri A. Christakis, MD, MPH, discussed the need for sustained, robust efforts to provide the infrastructure to support breastfeeding at all levels.

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Retail clinics have proliferated in response to patients’ demand for convenient health care access for minor illnesses. Garbutt and colleagues described the rationale and experiences of 1484 families with a pediatrician who also used retail clinics for pediatric care. Parents reported using the retail clinic instead of going to their pediatrician because of more convenient hours, no appointment was available, or they did not want to bother their pediatrician with seemingly minor illnesses. In an accompanying editorial, Edward L. Schor, MD, traced the history of retail clinics and discussed the changes pediatric practices must make to remain competitive.

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