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This Month in Archives of Pediatrics & Adolescent Medicine
Nov 2011

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2011;165(11):971-972. doi:10.1001/archpediatrics.2011.199

WhitakerArticle argues that the childhood obesity epidemic is a symptom of our way of living, and reversing the epidemic may require that we apply a new approach to improving child health. Societal changes to enhance human well-being may address not only obesity but other socially determined health conditions as well.

Wilson and PuckettArticle argue that child welfare reform should be driven less by moral outrage at egregious examples of child abuse and more by an epidemiological perspective on abuse. Offering voluntary services to high-risk families as early as possible will likely do more good than well-meaning initiatives aimed at reducing child abuse deaths.

The review by Wahi et alArticle found no apparent overall effect of the interventions on reduction of body mass index or reduction of screen time overall. However, there was a statistically significant reduction in screen time in the subgroup analysis of trials that focused on preschool children.

While body mass index screening is mandated in California for fifth-, seventh-, and ninth-grade students, parent notification of the results is optional. This study by MadsenArticle found that parental notification of body mass index in the fifth and/or seventh grade had no effect on subsequent body mass index compared with schools where there was no parental notification.

In this study by Taveras et alArticle of more than 40 000 children, crossing 2 or more weight-for-length percentile lines in the first 24 months of life doubled the odds of obesity at ages 5 and 10 years. The risk of obesity in later childhood was greatest for those who crossed 2 percentile lines in the first 6 months of life, emphasizing the early origins of childhood obesity.

Mansfield et alArticle report that parental deployment was associated with an increased risk of their children having a mental health diagnosis code in general and of acute stress reaction and adjustment disorders, depressive disorders, and pediatric behavioral disorders specifically. There was a clear dose response such that children of parents who spent more time deployed fared worse than children whose parents deployed for a shorter duration.

Dakil et alArticle found that of children remaining in the home after an abuse report, 44% were rereported within the 5-year follow-up period. Certain subgroups had the highest risk of reabuse; these data can guide efforts for more intensive monitoring and resources for selected families at highest risk.

Brinkman et alArticle report that, in general, low levels of shared decision making with parents were found around medication initiation. Lowest levels of shared decision making were found for parents of minority race, lower education, and lower socioeconomic status and with serious mental illness. Interventions to foster shared decision making appear warranted.

Kuo et alArticle report that families of more medically complex children with special health care needs spend 11 to 15 hours per week on direct home care. More than half reported financial problems, 54% reported that a family member was forced to quit work to care for the child, and 49% reported at least 1 unmet medical service need.

Schroeder et alArticle found that a more restrictive imaging algorithm for children younger than 2 years after a first febrile urinary tract infection resulted in no increase in the rate of recurrent infections. While detection of vesicoureteral reflux of grades 1 through 3 decreased, such children in the prealgorithm era underwent no interventions other than successive urinary tract imaging and prophylactic antibiotic use.

LaBella et alArticle report that a coach-led 20-minute warm-up resulted in a two-thirds reduction in the incidence of acute-onset noncontact lower extremity injuries, a 62% reduction in noncontact ankle sprains, a 70% reduction in noncontact knee sprains, and an 80% reduction in noncontact anterior cruciate ligament injuries.