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Effectiveness of Fundoplication at the Time of Gastrostomy
Concomitant fundoplication at the time of gastrostomy tube placement in neonates is used to prevent complications of reflux, but its effectiveness is unproven. In a cohort study of 4163 infants with neurological impairment at 42 children’s hospitals, Barnhart and colleagues found that those who also had fundoplication had more reflux-related hospitalizations in the next year than a matched control group without fundoplication. The authors also demonstrated a 75-fold variation in fundoplication rates across these 42 hospitals. In a related editorial, Rangel discusses the implications of this study on clinical practice and the need for the development of consensus practice guidelines.
Journal Club Slides, Continuing Medical Education
Breastfeeding and Obesity Among Schoolchildren
Although it is suggested that breastfeeding is protective against obesity in children, the evidence remains inconclusive because of possible residual confounding by socioeconomic status or lifestyle factors. In this longitudinal study of 43 367 children, Yamakawa and colleagues examined the rates of overweight and obesity at ages 7 and 8 years. The risk for overweight was 15% lower and obesity 45% lower at 7 years of age in children who were exclusively breastfed for the first 6 to 7 months of life compared with those fed formula. An accompanying editorial by Bovbjerg and colleagues suggests that “well-mother” checks in addition to well-baby visits should be scheduled for women within the first few days postpartum to promote breastfeeding and provide support and education.
Distraction, Attention-Deficit/Hyperactivity Disorder, and Driving Performance of Teen Drivers
While adolescents as a group are at increased risk for distracted driving, those diagnosed as having attention-deficit/hyperactivity disorder (ADHD) may present an even greater risk. Narad and colleagues studied 16- to 17-year-olds in a driving simulator. Adolescents with ADHD demonstrated more variability in speed and lane position than control subjects and texting significantly impaired the driving performance of all adolescents and increased existing driving-related impairment in adolescents with ADHD. In a related editorial, Winston and colleagues discuss the urgent need to address this perfect storm of novice drivers, some with attention problems, motor vehicles, and smart phone use.
Related Editorial, JAMA Pediatrics Patient Page
Recurrence of Autism Spectrum Disorders in Siblings
There has been great concern in both the lay and professional community about the recurrence risk for autism spectrum disorders (ASDs). This cohort study by Grønborg and colleagues in Denmark is the first to be population based and the first to consider the ASDs recurrence risk for full- and half-siblings. The overall risk for recurrence was about 7% and was nearly 7-fold higher for children with an older sibling with ASD compared with children without such a sibling, and it did not change over time. The relative recurrence risks were 2.4 for maternal half-siblings and 1.5 for paternal half-siblings. These estimates are substantially lower than recent reports from smaller, clinic-based populations.
Highlights. JAMA Pediatr. 2013;167(10):883. doi:10.1001/jamapediatrics.2013.2165
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