bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–06–28
35 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Pediatric cancer survival in the United States from 2001 to 2021.
  2. Insufficient Sleep Syndrome in Children and Adolescents.
  3. Ultrasound-Guided Nerve Blocks in Pediatric Emergency Medicine: A Scoping Review of the Published Literature.
  4. Advancing Youth Safety: How School Nurses Can Support Youth, Families, and Prevent Firearm Injuries.
  5. Language-Related Safety Disparities Following a Health Literacy-Informed Rounds Intervention.
  6. Consensus on Neonatal and Pediatric Interfacility Transport.
  7. Hypertension in Children: Narrative Review of Epidemiology, Outcome and Target Organ Damage.
  8. Rates and Factors associated with Short Stay Admissions and Readmissions Among Children and Youth with Complex Chronic Conditions.
  9. Cost of pediatric gastroenteritis hospitalizations in the United States.
  10. Too Complex to Treat? Equity in Access to Inpatient Pediatric Pain Rehabilitation.
  11. Strengthening Advocacy Through Clinician Partnerships with Government Relations and Other Policy Experts: Recent Advances.
  12. Implementing the National Pediatric Readiness Project in Community Emergency Departments: A CFIR 2.0-Guided Qualitative Study of Academic Medical Center Partner Perceptions.
  13. Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents: Clinical Report.
  14. Prediction model for children with anaphylaxis who may not require emergency department care: a multicenter retrospective cohort study.
  15. Topical Review: Integrating pediatric psychology into PICUs: improving screening and interventions for medical trauma.
  16. Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.
  17. Hard to Handle: Penetrating Bicycle Handlebar Injuries in Children, 2005-2024.
  18. Augmenting Pediatric Care With Artificial Intelligence: Opportunities and Responsibilities for Nurse Practitioners.
  19. Pediatric Autism Identification in Primary Care from 2013 to 2023.
  20. Fixed Dose Combinations as an Advantage for the Treatment of Pediatric Tuberculosis: A Narrative Review.
  21. Barriers and Facilitators of Inpatient Vaccine Delivery at US Children's Hospitals: A Qualitative Study.
  22. Child Opportunity Index and Youth Mental Health Emergency Department Visits.
  23. Rapid MRI for Pediatric Patients: Indications, Protocols, and High-Yield Diagnoses for Emergency Radiologists.
  24. Insurance Hurdles for Laser Authorization in Pediatric Patients.
  25. Hot or Not? Myths and Misconceptions About Antipyretics for Pediatric Fever.
  26. Practical approach to the diagnosis, management, and treatment of pediatric patients with bone fragility: an expert opinion.
  27. Social media negatively affects children and adolescents.
  28. Needs and Perspectives on Upper Limb Prostheses Among Children and Adolescents With Upper Limb Differences.
  29. Universal Autism Screening in Early Learning Programs: A Feasibility Study.
  30. Inequitable Reimbursement for Pediatric Providers: A Review of Structural Factors that Disincentivize the Care of Children.
  31. Unintentional ingestion of recreational drugs among young children, 2000-2024.
  32. Implementation of an Institutional Asthma Care Guideline in Hospitalized Children: Effects on Clinical Outcomes and Healthcare Resource Utilization.
  33. A Budding Problem: A 20-Year National Analysis of Pediatric Earbud Injuries.
  34. Operative Treatment Versus Spica Casting for Treatment of Pediatric Femoral Shaft Fractures in Children Aged 4 to 6 Years: A Large Multi-Institutional Age-Stratified Comparative Analysis.
  35. Clinical Characteristics and Associated Comorbidities in Children and Adolescents With Type 1 Diabetes Mellitus: A Retrospective Study.
  1. Cancer. 2026 Jul 01. 132(13): e70505
    Pediatric cancer survival in the United States from 2001 to 2021.
    Jason M Stevenson, Philip J Lupo, Tamara P Miller, Shifan Dai, S Jane Henley, Eric Tai, Michael A Boring, David A Siegel.
       BACKGROUND: Approximately 15,000 United States (US) children and adolescents, 0-14 and 15-19 years old, respectively, are diagnosed with cancer annually. Although overall survival now exceeds 80%, cancer remains the second leading cause of death in this population, and improvements have not been uniform across subgroups.
    METHODS: Five- and 10-year relative survival (RS) for cancer cases diagnosed during 2001-2021 among individuals <20 years old at diagnosis were calculated using the National Program of Cancer Registries database, covering 87.4% of the US population. Results were stratified by age, sex, race and ethnicity, US Census region, economic status, cancer type, stage, and diagnosis year. All-cause survival was calculated using the Kaplan-Meier method with log-rank testing.
    RESULTS: Among 272,279 pediatric cancers diagnosed from 2001 to 2021, 5-year RS was 84.7%, and 10-year RS was 82.3%. Five-year RS increased from 83.0% in 2001-2011 to 86.8% in 2012-2021. Ten-year RS was higher for females than males. By age, adolescents 15-19 years old had the highest RS, whereas infants had the lowest. Non-Hispanic Black patients had the lowest 5- and 10-year RS (79.2% and 76.3%, respectively) compared with non-Hispanic White patients (86.3% and 84.0%). RS was highest for patients in the top 25% of counties by economic status and in the Northeastern US Census region. Overall, all-cause 10-year survival was 81.7% and differed by sex, age, race and ethnicity, stage, and cancer subtypes.
    CONCLUSIONS: Pediatric cancer survival has continued to improve. However, differences persist by age, sex, race and ethnicity, economic status, geography, and cancer type.
    Keywords:  United States; adolescent; child; ethnicity; health status disparities; neoplasms; population surveillance; socioeconomic factors; survival rate
    DOI:  https://doi.org/10.1002/cncr.70505
  2. Children (Basel). 2026 Jun 11. pii: 803. [Epub ahead of print]13(6):
    Insufficient Sleep Syndrome in Children and Adolescents.
    Jun Kohyama.
      In this Special Issue of Children, entitled "Insufficient Sleep Syndrome in Children and Adolescents", recent advances in pediatric sleep medicine are explored through several diverse and thought-provoking perspectives on insufficient sleep syndrome (ISS) across developmental stages and clinical contexts [...].
    DOI:  https://doi.org/10.3390/children13060803
  3. Pediatr Emerg Care. 2026 Jun 26.
    Ultrasound-Guided Nerve Blocks in Pediatric Emergency Medicine: A Scoping Review of the Published Literature.
    Richard J Gawel, Jennifer X Hong, Cassandra L Stegall, Jennifer Lege, Aaron E Chen, Mary Kate Claiborne, Michael Shalaby.
       CONTEXT: Ultrasound-guided nerve blocks (UGNBs) are increasingly used in the emergency department (ED) to provide effective, opioid-sparing analgesia. Although their use is well described in adult emergency medicine, the scope, indications, and safety of UGNBs in pediatric emergency medicine remain less well defined.
    OBJECTIVE: To characterize the published literature describing emergency physician-performed UGNBs in pediatric emergency medicine to identify trends and directions for future research.
    DATA SOURCES: We electronically searched the PubMed/MEDLINE, Scopus, Embase, and Wiley Cochrane libraries from database inception through March 23, 2026.
    STUDY SELECTION: We included original studies describing UGNBs performed in pediatric patients by emergency physicians in the ED.
    DATA EXTRACTION: Three authors independently reviewed included articles and abstracted data on study characteristics, patient populations, UGNB types, clinical indications, anesthetics and adjuvants, and reported adverse events.
    RESULTS: From an initial database search of 5917 unique articles, 37 articles were included encompassing 440 pediatric patients who received 462 UGNBs. Twenty-one different UGNB types were described, most commonly femoral nerve blocks (8 articles, 22%; 128 blocks, 28%) and fascia iliaca compartment blocks (3 articles, 8.1%; 124 blocks, 27%) for hip and femur fracture analgesia. Two self-limited UGNB-related adverse events (0.5%) were reported, with no long-term sequelae. Study designs were heterogeneous, with substantial variability in reporting practices and frequent inclusion of mixed adult-pediatric cohorts.
    CONCLUSIONS: Emergency physician-performed UGNBs are increasingly reported in pediatric emergency medicine. Reported complication rates are low. The overall heterogeneous and limited evidence base highlights the need for larger, prospective studies to better define the role of UGNBs in pediatric emergency care.
    Keywords:  analgesia; pain management; regional anesthesia; ultrasound-guided nerve block
    DOI:  https://doi.org/10.1097/PEC.0000000000003647
  4. NASN Sch Nurse. 2026 Jul;41(4): 159-163
    Advancing Youth Safety: How School Nurses Can Support Youth, Families, and Prevent Firearm Injuries.
    Karma E Wilson, Kelitah Armstrong, Robin Cogan, Leslie Helmcamp, Amy Park, Samaa Kemal, Karen Sheehan.
      Firearm injury prevention efforts play a critical role in addressing both morbidity and mortality associated with firearms among children and adolescents. School nurses, through their clinical expertise and trusted relationships with students and families, are uniquely positioned to contribute to and influence these prevention efforts. Nurses can engage in meaningful, respectful conversations during initial or brief encounters and through ongoing communication. This article provides an overview of firearm violence among youth and offers practical tools and resources for school nurses. These resources empower school nurses as trusted messengers, strengthening their ability to lead courageous, life-saving conversations around sensitive health and safety issues, including firearm injury prevention.
    Keywords:  best practice; community; evidence-based; interpersonal relations; public health; risk reduction; role of the school nurse; safety/injury prevention; school nurses; security; students; whole child (WSCC); whole community; whole school; youth safety
    DOI:  https://doi.org/10.1177/1942602X261459582
  5. Hosp Pediatr. 2026 Jun 23. pii: e2025008963. [Epub ahead of print]
    Language-Related Safety Disparities Following a Health Literacy-Informed Rounds Intervention.
    H Shonna Yin, Alisa Khan, Alexander F Glick, Dionne A Graham, Wilma Alvarado-Little, Jennifer D Baird, Sharon Cray, Nandini Mallick, Theodore C Sectish, Nancy D Spector, Benard P Dreyer, Christopher P Landrigan.
       OBJECTIVE: To examine whether disparities in preventable adverse events (AEs) and family experience for hospitalized children of parents with and without limited comfort with English (LCE) changed following implementation of a health literacy-informed, structured family-centered rounds intervention, Patient and Family Centered I-PASS.
    METHODS: Seven-center prospective before and after intervention study conducted from December 2014 to January 2017. Inclusion criteria includes parents and caregivers of hospitalized children less than 18 years old. LCE defined as parent and caregiver reporting any language other than English as the language in which they were most comfortable speaking to physicians and nurses. Preventable AE rates determined via (1) daily medical record surveillance, solicited clinician reports, hospital incident reports, and family safety interviews, followed by (2) dual-physician masked review and consensus rating. Changes assessed through multivariable mixed-effects logistic regression, controlling for complex chronic conditions, length of stay, parent race and ethnicity, education, and clustering by site. Family experience assessed via predischarge survey (6 domains, 5-point scale). Mixed-effects linear regression estimated changes in mean domain scores by language comfort.
    RESULTS: Of 1666 patients, 8.8% (n = 147) had parents with LCE. Preimplementation, over twice as many children of parents expressing LCE experienced preventable AEs, compared with children of parents expressing comfort with English (18.8% vs 7.6%; P = .001; adjusted odds ratio, 3.29; 95% CI, 1.48-7.31). Postimplementation, there were no significant differences between groups (6.4 vs 5.3%; P = .68; adjusted odds ratio, 1.26; 95% CI, 0.42-3.75). Some domains of family experience improved for both groups, although disparities in experience persisted in nurse communication.
    CONCLUSIONS: Patient safety disparities related to parental comfort with English narrowed after implementing a family-centered rounds communication intervention.
    DOI:  https://doi.org/10.1542/hpeds.2025-008963
  6. Air Med J. 2026 Jul-Aug;45(4):pii: S1067-991X(26)00031-3. [Epub ahead of print]45(4): 414-420
    Consensus on Neonatal and Pediatric Interfacility Transport.
    Corina Noje, Ranna Rozenfeld, Robert G Holcomb, Michele Moss, Franscesca Miquel Verges, Scott Saunders, Tammy Rush, Jan Eichel, Don Null, Richard Zimmerman, Lisa Pruitt, Emily Krennerich, Matthew Harris, Rudy Kink, Webra Price Douglas, Hamilton Schwartz, Michael H Stroud.
      The practice of neonatal/pediatric transport medicine continues to advance. Teams have evolved from providing critical care outside tertiary care centers to participating in collaborative research efforts, benchmarking and quality improvement, developing innovative partnerships, and pushing the limits of care provision during interfacility transport. The most recent consensus document on neonatal and pediatric transport medicine was published more than a decade ago. Advancements in the field necessitate the dissemination of new practices in transport medicine. The following manuscript details the current evidence-supported, expert consensus opinions on the practice of neonatal and pediatric transport medicine and recommendations for its future direction.
    DOI:  https://doi.org/10.1016/j.amj.2026.02.004
  7. Children (Basel). 2026 Jun 18. pii: 831. [Epub ahead of print]13(6):
    Hypertension in Children: Narrative Review of Epidemiology, Outcome and Target Organ Damage.
    Joseph Mahgerefteh.
      Hypertension is the leading risk factor for cardiovascular disease. Epidemiologic studies have demonstrated that pediatric hypertension may increase the risk of premature heart disease. Pediatric hypertension affects about 4% of children and clusters with other risk factors and social disparities in health. In addition to observed target organ damage, there is evidence for tracking blood pressure from childhood to adulthood. Ambulatory blood pressure monitoring is the recommended method for diagnosis, and echocardiography is used to assess target organ damage. A diagnostic workup in children depends on the age at presentation, severity of hypertension, diurnal pattern, evidence of target organ damage, and response to treatment. Treatment follows a similar framework to adult hypertension and studies demonstrate improvement in intermediate outcomes with treatment. However, further studies are needed to establish benefit in hard outcomes. This review focuses on studies evaluating the epidemiology of pediatric hypertension and its association with cardiovascular outcomes. Relevant domains included prevalence, blood pressure tracking, and cardiovascular sequelae. To compile data for this narrative review, a PubMed/MEDLINE database search was performed for studies published between 1997 and April 2026.
    Keywords:  cardiovascular; epidemiology; hypertension; pediatric; target organ damage
    DOI:  https://doi.org/10.3390/children13060831
  8. Acad Pediatr. 2026 Jun 25. pii: S1876-2859(26)00142-7. [Epub ahead of print] 103360
    Rates and Factors associated with Short Stay Admissions and Readmissions Among Children and Youth with Complex Chronic Conditions.
    Brigid Garrity, Patrice Melvin, Jay G Berry, Anne M Stack, Kathleen Huth, Stacey C Cook, Todd W Lyons.
       OBJECTIVE: Our objectives were to assess the rates of, variation in, and factors associated with short stay admissions (SSAs) and 7-day hospital readmissions after SSAs for children with complex chronic conditions (CCCs).
    METHODS: Retrospective analysis of children with > 1 CCC who had a ≤ 1-day admission from 1/1/2018 to 6/30/2025 in 47 children's hospitals in the Pediatric Health Information System. We conducted a multivariate analysis to examine risk factors for SSAs and 7-day readmissions after SSAs. Covariates included demographics, clinical factors, child opportunity index (COI), and ambulatory care sensitive conditions (ACSCs).
    RESULTS: Of 1,268,019 hospital admissions for children with > 1 CCC, 23.3% (n=295,264) were SSAs, and the rate of SSA varied significantly across hospitals (range: 17.1-29.9%). Higher odds of SSA were associated with high COI, having only one CCC, and admission for ACSC. The 7-day hospital readmission after SSA was 5.8%. Higher odds of readmission were associated with more than one CCC and prior ICU admission.
    CONCLUSIONS: SSAs accounted for nearly one-in-four admissions for children with CCCs, and 7-day readmission rates after SSAs were low. Short stay admissions may represent opportunities to prevent unnecessary hospitalizations for children with CCCs.
    Keywords:  brief admissions; complex chronic conditions; readmissions
    DOI:  https://doi.org/10.1016/j.acap.2026.103360
  9. J Hosp Med. 2026 Jun 21.
    Cost of pediatric gastroenteritis hospitalizations in the United States.
    Kenneth A Michelson, Sriram Ramgopal.
      Gastroenteritis is a common cause of pediatric hospitalization. We sought to determine the national costs of pediatric gastroenteritis hospitalizations. We conducted a cross-sectional study of children under 18 years old hospitalized for gastroenteritis using the Kids Inpatient Database of 2016, 2019, and 2022. The outcome was inflation-adjusted cost using cost-to-charge ratios. We determined hospitalization counts, summarized costs, and constructed a linear regression model evaluating demographic features associated with cost. There were 127,630 hospitalizations in the 3 years, of which 69,379 (54.4%) hospitalizations occurred among children under 3 years old. National costs were $285 million in 2016, $276 million in 2019, and $305 million in 2022. Median (interquartile range) per-hospitalization costs were $4029 (2452-6997). Compared with no complex chronic conditions, having 1, 2, or ≥3 was associated with 48.2% (95% CI 45.2, 51.3), 111% (95% CI 104, 119), and 194% (95% CI 179, 209) higher adjusted costs. Gastroenteritis generates substantial hospitalization costs.
    DOI:  https://doi.org/10.1002/jhm.70371
  10. Hosp Pediatr. 2026 Jun 24. pii: e2025009131. [Epub ahead of print]
    Too Complex to Treat? Equity in Access to Inpatient Pediatric Pain Rehabilitation.
    Beth Links Torwekar, Amanda Chiapa, Sarah Kotel, Vanessa Verboort.
      An adolescent with complex regional pain syndrome, functional neurological symptoms, and significant psychosocial complexity was hospitalized for severe decline. Despite meaningful progress through a structured, multidisciplinary inpatient approach, she was repeatedly denied admission to pediatric inpatient pain rehabilitation programs across the United States-often based on process requirements such as caregiver engagement, outpatient intake completion, and medical or psychiatric complexity. These denials delayed access to intensive, coordinated care previously shown to benefit her. This case illustrates how the intersection of medical and psychosocial complexity can operate as an unspoken exclusion criterion in pediatric pain rehabilitation, disproportionately affecting vulnerable youth. Policies and eligibility checklists intended to optimize outcomes may inadvertently reinforce inequities when applied without attention to context. We argue that readiness should not be defined solely by patient or family characteristics but by the health system's capacity to respond to complexity with flexibility and equity. We propose system-level strategies to promote equitable access: requiring clinician-to-clinician dialogue before denials are issued, creating formal appeal pathways to reconsider complex cases, clarifying and publishing admission criteria, and designing inclusive rehabilitation tracks. Rather than asking whether patients are ready for our programs, we must ask whether our programs are prepared to meet our patients.
    DOI:  https://doi.org/10.1542/hpeds.2025-009131
  11. Acad Pediatr. 2026 Jun 22. pii: S1876-2859(26)00146-4. [Epub ahead of print] 103364
    Strengthening Advocacy Through Clinician Partnerships with Government Relations and Other Policy Experts: Recent Advances.
    Amanda M Stewart, Lois K Lee, Jessica L Bettenhausen, Lenore R Jarvis, Anita N Shah, David Keller, Lauren K Gambill.
      
    Keywords:  Child Advocacy; Health Policy; Interdisciplinary Communication; Lobbying; Staff Development
    DOI:  https://doi.org/10.1016/j.acap.2026.103364
  12. Pediatr Emerg Care. 2026 Jun 26.
    Implementing the National Pediatric Readiness Project in Community Emergency Departments: A CFIR 2.0-Guided Qualitative Study of Academic Medical Center Partner Perceptions.
    Elizabeth Sanseau, Cage Cochran, Ibnat Meah, Erin Montgomery, Ben Michaels, Cynthia Mollen, Marc Auerbach.
       OBJECTIVES: The National Pediatric Readiness Project (NPRP) offers an evidence-based framework for pediatric emergency readiness, yet implementation in general emergency departments (GEDs) remains variable. The Pediatric Emergency Care Coordinator (PECC) is the central driver of NPRP operationalization. The Improving Pediatric Acute Care Through Simulation (ImPACTS) collaborative formalized the Academic Medical Center (AMC) Partner role-experienced pediatric emergency clinicians providing structured NPRP implementation support to GED PECCs. We characterized AMC Partners' perceptions of barriers and facilitators to GED NPRP implementation and how AMC Partner facilitation supports PECC operationalization across diverse community settings.
    METHODS: Using the Consolidated Framework for Implementation Research (CFIR 2.0), we conducted semi-structured interviews with 23 AMC Partners (11 physicians, 12 nurses) from the 2023 ImPACTS collaborative, analyzed using hybrid thematic analysis organized by CFIR 2.0 domains.
    RESULTS: Implementation determinants spanned all 5 CFIR 2.0 domains. AMC Partners described the NPRP as a legitimizing framework, with GED implementation depending on leadership engagement, protected administrative time, and relationship-based facilitation. Workforce instability, role ambiguity, and low pediatric volume were persistent barriers. AMC Partners functioned as boundary spanners, translating NPRP standards into local action through site visits, simulation-based systems testing, Pediatric Readiness Score audit and feedback, and iterative mentorship. Absence of regional AMC Partner networks was a critical gap.
    CONCLUSIONS: Successful NPRP implementation requires more than PECC designation. Leadership support, protected time, and structured AMC Partner facilitation are essential. These findings inform development of regional AMC Partner network models to extend support to community, rural, frontier, and Tribal emergency departments.
    Keywords:  Consolidated Framework for Implementation Research; National Pediatric Readiness Project; Pediatric Emergency Care Coordinator; community emergency department; implementation science; pediatric emergency readiness; qualitative research; simulation-based medical education
    DOI:  https://doi.org/10.1097/PEC.0000000000003643
  13. Pediatrics. 2026 Jun 22. pii: e2026077414. [Epub ahead of print]
    Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents: Clinical Report.
    AAP Section on Hematology-Oncology
      This clinical report includes strategies for the prevention of iron deficiency (ID) and iron deficiency anemia (IDA), updates for screening, as well as diagnostic and treatment recommendations. It relates broadly to children, from birth through adolescence, affected by either nutritional ID or IDA attributable to insufficient dietary iron, malabsorption, or loss of iron from heavy menstrual, gastrointestinal, or other external blood loss. Recommended diagnostic strategies emphasize important features of the history, physical examination, and informative laboratory tests available to both generalists and subspecialists. Treatment of children with ID, mild IDA, and moderate or severe IDA or when IDA is refractory or recurrent is discussed. Recommendations regarding oral iron therapy and intravenous iron treatment options are described.
    DOI:  https://doi.org/10.1542/peds.2026-077414
  14. J Allergy Clin Immunol Pract. 2026 Jun 24. pii: S2213-2198(26)00513-1. [Epub ahead of print]
    Prediction model for children with anaphylaxis who may not require emergency department care: a multicenter retrospective cohort study.
    Timothy E Dribin, David Schnadower, Hugh A Sampson, Yin Zhang, Nanhua Zhang, Stephen B Freedman, Mark I Neuman, David C Brousseau, Rakesh D Mistry, Stephanie Boyd, Yonatan Wolnerman, Patrick S Walsh, Craig Vander Wyst, Vandana Thapar, Jonathan Strutt, Geetanjali Srivastava, Nidhi V Singh, Christopher J Russo, Christian D Pulcini, Thuy L Ngo, Jo-Ann O Nesiama, Matthew M Moake, Ashley M Metcalf, Tamar R Lubell, Juhee Lee, Chari D Larsen, Karen Y Kwan, Curtis L Knoles, Kajal Khanna, Julia F Freeman, Justin R Davis, Alicia Daggett, Joanna S Cohen, Ari R Cohen, Wee-Jhong Chua, Sri S Chinta, Brittany Boswell, Kelly R Bergmann, Paul L Aronson, Kenneth A Michelson.
       BACKGROUND: The 2023 US Anaphylaxis Practice Parameter indicated that some patients receiving epinephrine in the community might avoid emergency department (ED) visits; however, the criteria and safety of this approach remain unproven.
    OBJECTIVE: To derive and validate a clinical prediction model for identifying children at risk of receiving epinephrine after arriving at the ED.
    METHODS: We conducted a 31-center retrospective cohort study of children aged 6 months to <18 years who received one pre-ED dose of epinephrine for allergic reactions between 2016 and 2019. The outcome was receipt of epinephrine after ED arrival. We used LASSO regression to derive the model in 70% of the patients to identify pre-ED factors associated with epinephrine administration. Internal and external validations included 20% and 10% of the cohort, respectively.
    RESULTS: The 2318 eligible patients had a median age of 8.4 years (IQR, 3.8-13.4), and 15.7% (n = 364) received epinephrine after ED arrival. Prehospital factors associated with the receipt of additional epinephrine included a history of asthma, cardiovascular symptoms before epinephrine, persistent symptoms after epinephrine, and any new/recurrent respiratory, cardiovascular, gastrointestinal, or non-specific symptoms after epinephrine. In the external validation, 30% (65/216) of encounters were classified as low risk. The presence of any risk factor had a sensitivity of 0.93 (95% CI 0.80, 0.98), specificity of 0.35 (95% CI 0.28, 0.43), positive predictive value of 0.25 (95% CI 0.18, 0.33), and negative predictive value of 0.95 (95% CI 0.87, 0.99) for identifying patients who received epinephrine after ED arrival.
    CONCLUSION: We developed and validated a clinical prediction model to identify children treated with a single prehospital dose of epinephrine who may not require ED care. Implementation of the model could reduce avoidable ED visits for children with anaphylaxis.
    Keywords:  acute allergic reactions; anaphylaxis; epinephrine; prehospital; refractory anaphylaxis
    DOI:  https://doi.org/10.1016/j.jaip.2026.06.021
  15. J Pediatr Psychol. 2026 Jun 23. pii: jsag040. [Epub ahead of print]
    Topical Review: Integrating pediatric psychology into PICUs: improving screening and interventions for medical trauma.
    Kristin Canavera, Nicole M Schneider, Saad Ghafoor, Emily Mudd.
       OBJECTIVE: Provide an overview of medical traumatic stress in pediatric critical care and highlight pediatric psychology as a central mechanism for translating evidence into trauma-informed screening, prevention, and intervention practices within pediatric intensive care units (PICUs).
    METHODS: Current literature is synthesized to characterize medical traumatic stress, identify trauma-informed practice guidelines, and propose recommendations for improved integration of pediatric psychology into critical care settings.
    RESULTS: High rates of medical traumatic stress and posttraumatic stress disorder (PTSD) are reported among critically ill children, caregivers, and PICU staff, with identifiable risk factors. Current and emerging standards of care reviewed include traumatic stress and delirium screening, early mobility initiatives, PICU follow-up programs, trauma-focused interventions, and staff debriefing efforts.
    CONCLUSIONS: Medical traumatic stress is a common outcome of PICU hospitalization. Earlier integration of pediatric psychology services during and following PICU admission offers promise for improving outcomes, advancing trauma-informed care, and informing future research across the PICU continuum.
    Keywords:  critically ill children; dissemination and implementation science; integrated behavioral health; posttraumatic stress and trauma
    DOI:  https://doi.org/10.1093/jpepsy/jsag040
  16. Ann Surg Open. 2026 Jun;7(2): e664
    Safety Assessment of Perioperative Pain Medications for Children: Variation in Opioid Prescribing at Discharge.
    Mallory N Perez, Lynn Huang, Willemijn L A Schäfer, Alison J Lehane, Charesa J Smith, Sarah Kennedy, Jane L Holl, Charles J Aprahamian, Srikumar B Pillai, Bethany J Slater, Mehul V Raval.
       Objective: To characterize factors contributing to opioid prescribing practice variation at discharge for children after surgery and evaluate the association between discharge opioid prescribing and 30-day follow-up/complications.
    Background: Efforts to optimize opioid use in children after surgery are currently limited by insufficient information about prescribing practice variation. This paper comprehensively examines discharge opioid prescribing practices across pediatric surgical specialties and hospitals.
    Methods: Prospective cohort study of 1670 children (5-17 years) from 4 Illinois hospitals participating in the National Surgical Quality Improvement Program-Pediatric, using electronic health record data abstracted from January 2021 to April 2023. Primary outcome measures were opioid exposure (receiving an opioid prescription at discharge) and opioid dose intensity (total morphine milligram equivalents [MMEs] prescribed) at discharge. Associations between each of the primary outcomes and patient/clinical factors were evaluated with multivariable logistic and multivariable linear regressions.
    Results: In total, 566 (34%) children had an opioid exposure with median dose intensity 80 MMEs/prescription (interquartile range: 50-125) at discharge. Hospital site, older age (Odds ratio [OR], 2.78 [95% confidence interval (CI), 2.03-3.82]; β = 47.12, P < 0.001), preoperative non-opioid analgesia use (OR, 2.42 [95% CI, 1.63-3.62]; β = 26.84, P < 0.001), and regional anesthesia use (OR, 10.14 [95% CI, 5.12-20.02]; β = 25.77, P = 0.03 ) were associated with opioid exposure and dose intensity. Surgical specialties with increased opioid exposure did not correspond with those with higher dose intensity. Lack of opioid exposure at discharge was not associated with pain control issues requiring follow-up care.
    Conclusions: Significant variation by hospital and surgical specialty exists in opioid exposure and dose intensity for children after surgery. Both opioid exposure and dose intensity offer valuable, complementary insights, and therefore, should be monitored to fully optimize opioid stewardship in children after surgery.
    Keywords:  opioid; pain management; pediatric; quality improvement; surgery
    DOI:  https://doi.org/10.1097/AS9.0000000000000664
  17. J Surg Res. 2026 Jun 24. pii: S0022-4804(26)00343-4. [Epub ahead of print]325 384-393
    Hard to Handle: Penetrating Bicycle Handlebar Injuries in Children, 2005-2024.
    Seth J Weir, Yoli Meydan, Jacob N Bamberger, Leah Samuels, Kenneth W Gow, Richard Scriven, Helen Hsieh, Kristen Calabro.
       INTRODUCTION: Blunt bicycle handlebar injuries in children are well described; however, penetrating injuries caused by handlebar ends or brake levers remain poorly characterized. We sought to describe the epidemiology, injury patterns, and clinical outcomes of penetrating bicycle handlebar injuries in children using a national emergency department surveillance dataset.
    METHODS: We conducted a retrospective cross-sectional study using National Electronic Injury Surveillance System data from 2005 to 2024 and identified bicycle handlebar injuries in pediatric patients (≤21 y). Using diagnosis codes for puncture wounds and foreign bodies and narrative keyword searches, cases of penetrating trauma were identified. Exclusion criteria included nonhandlebar, superficial, or ambiguous cases.
    RESULTS: Among 12,939 handlebar-related bicycle injuries, 127 cases met criteria for penetrating handlebar injury (national estimate ∼3078 cases). Most penetrating injuries were puncture wounds (109/127, 85.8%), while 18/127 (14.2%) involved a retained foreign body. Penetrating injuries were concentrated in school-age children (5-14 y) and occurred most in the upper leg and abdomen. Compared with nonpenetrating handlebar injuries, penetrating injuries were associated with significantly higher hospitalization rates and remained independently associated with hospitalization after adjustment (adjusted odds ratio ∼6.30, 95% confidence interval 4.23-9.39, P < 0.001).
    CONCLUSIONS: Penetrating bicycle handlebar injuries, while rare, are associated with substantially increased hospitalization compared with nonpenetrating handlebar trauma. These findings support targeted prevention efforts in school-age children and highlight the importance of safer handlebar and brake lever design.
    Keywords:  Bicycle; Handlebar; Pediatric; Penetrating; Trauma
    DOI:  https://doi.org/10.1016/j.jss.2026.05.051
  18. J Pediatr Health Care. 2026 Jun 26. pii: S0891-5245(26)00199-9. [Epub ahead of print]
    Augmenting Pediatric Care With Artificial Intelligence: Opportunities and Responsibilities for Nurse Practitioners.
    Richard Ricciardi.
       BACKGROUND: Artificial intelligence (AI) is emerging as a critical tool for nurse practitioners delivering pediatric and adolescent and young adult (AYA) care across primary, acute, and community settings.
    SEARCH SOURCE: This narrative review used targeted searches of PubMed, CINAHL, and policy reports (2020-2026) focused on AI, pediatrics, clinical decision support, digital health, and AYA care.
    RESULTS: AI is positioned to personalize education, strengthen clinical decision support, improve immunization outreach, support triage and antimicrobial stewardship, and enable proactive asthma monitoring. For AYA, AI may also support confidential reproductive health education, contraception and STI prevention reminders, and mental health screening when developmentally calibrated and clinically supervised.
    CONCLUSIONS: AI can enhance the reach, precision, and effectiveness of NP practice while advancing patient and family-centered care; however, implementation requires pediatric and AYA specific validation, equity-centered design, transparent governance, privacy safeguards, and clinician oversight.
    Keywords:  Artificial intelligence, pediatrics, nurse practitioner, digital health, clinical decision support
    DOI:  https://doi.org/10.1016/j.pedhc.2026.06.003
  19. Acad Pediatr. 2026 Jun 22. pii: S1876-2859(26)00136-1. [Epub ahead of print] 103354
    Pediatric Autism Identification in Primary Care from 2013 to 2023.
    Vincent Sutherland, Toby D Hocking, David C Folch, Veronica I Underwood Carrasco, Katharine E Zuckerman, Olivia J Lindly.
       OBJECTIVES: Autism spectrum disorder (ASD) is typically diagnosed by specialists; however, long waitlists and provider shortages can limit access. Primary care providers (PCPs) are frequently the first point of contact for families and may be well-positioned to recognize early developmental concerns. This study examined whether PCPs were increasingly reported as the first providers to tell families their child has ASD, and evaluated differences by race, ethnicity, and household income.
    METHODS: We analyzed National Survey of Children's Health (NSCH) data, restricting analysis to reported ASD identification from 2013 onward to align with the timing of changes to the DSM-5 ASD diagnostic criteria. Using generalized estimating equations, we assessed changes over time in the proportion of families who were first told their child had ASD by a PCP. Child's diagnostic age, race and ethnicity, and household income were covariates in the model.
    RESULTS: During 2013-2023, the percentage of families first told their child had ASD by a PCP ranged from 10.7% to 21.5% (average = 16.2%). After 2018, the likelihood of families reporting a PCP as the first provider increased, with statistically significant increases among Hispanic children and children from low-income households. The average age of =children when families were first told (5.3 years) remained stable over the study period.
    CONCLUSIONS: From 2013 to 2023, PCPs remained a minority source to first tell a family about their child's ASD. They were more often reported as the first providers to tell families in more recent years (2018-2023), particularly for Hispanic or low-income families.
    Keywords:  Autism spectrum disorder; National Survey of Children’s Health; diagnosis; health disparities; identification; pediatrics; primary care
    DOI:  https://doi.org/10.1016/j.acap.2026.103354
  20. Pharmaceuticals (Basel). 2026 May 22. pii: 806. [Epub ahead of print]19(6):
    Fixed Dose Combinations as an Advantage for the Treatment of Pediatric Tuberculosis: A Narrative Review.
    Susanna Esposito, Beatrice Rita Campana, Gaia Giorgia Arnesano, Nicola Principi.
      Background: Pediatric tuberculosis (TB) remains a major global health concern, accounting for a substantial proportion of TB-related morbidity and mortality worldwide. Treatment in children is particularly challenging due to age-specific pharmacokinetics, difficulties in drug administration, poor palatability, and reliance on caregivers for adherence. Objectives: This narrative review aims to evaluate the advantages and limitations of fixed-dose combinations (FDCs) in the treatment of pediatric TB, with a focus on adherence, pharmacological considerations, clinical outcomes, and implementation challenges. Methods: A narrative review of the literature was conducted, including clinical studies, pharmacokinetic analyses, programmatic data, and international guidelines related to the use of FDCs in pediatric TB management. Results: Evidence indicates that pediatric FDCs significantly improve treatment adherence by reducing pill burden and simplifying dosing regimens. They also decrease the risk of medication errors and inadvertent monotherapy, thereby contributing to the prevention of drug resistance. The availability of dispersible, child-friendly formulations has enhanced acceptability and ease of administration. However, limitations persist, including reduced flexibility in dose individualization, challenges in identifying the causative agent in adverse drug reactions, and variable access across settings. Pharmacokinetic concerns, particularly regarding rifampicin exposure, have been addressed in newer WHO-recommended formulations. Conclusions: FDCs represent a critical advancement in pediatric TB management and are strongly supported by international guidelines. Further research is needed to optimize formulations, ensure equitable access, and evaluate long-term clinical outcomes in diverse pediatric populations.
    Keywords:  WHO guidelines; adherence; child-friendly formulations; fixed-dose combinations; pediatric tuberculosis; pharmacokinetics
    DOI:  https://doi.org/10.3390/ph19060806
  21. Pediatrics. 2026 Jun 24. pii: e2025075278. [Epub ahead of print]
    Barriers and Facilitators of Inpatient Vaccine Delivery at US Children's Hospitals: A Qualitative Study.
    Mersine A Bryan, Alexandra J Mihalek, Richard Torres, Sanyukta Desai, Susan Wu, Erin Avondet, Rachel Solstad, Vanessa McFadden, Rena Kasick, Sumeet Banker, Daniel C Williams, Sunita Hemani, Catherine S Forster, Douglas J Opel.
      
    BACKGROUND: Despite many hospitalized children missing recommended vaccines, vaccines are rarely administered during hospitalization. Our objective was to explore the key determinants for inpatient vaccine delivery in a sample of 11 US children's hospitals.
    METHODS: We used the Pediatric Health Information System database to identify children's hospitals in the Pediatric Research in Inpatient Setting network who were in the top tertile (n = 6) and the bottom tertile of inpatient vaccine administration (n = 5). We recruited pediatric nurses, pharmacists, and hospitalists to participate in semistructured interviews. Interview questions were based on the Consolidated Framework for Implementation Research and focused on current practices and barriers to inpatient vaccine delivery. Interviews were conducted via telephone or teleconferencing and were recorded and transcribed. Two reviewers independently coded transcripts using thematic analysis; a third reviewer resolved discrepancies, as needed.
    RESULTS: We conducted 36 interviews: 10 hospitalists, 14 nurses, and 12 pharmacists. Several themes emerged as key determinants for inpatient vaccine delivery, including the following: 1) timing: vaccine administration happened predominately at discharge, which at times jeopardized vaccine delivery; 2) access: vaccinating during hospitalization was particularly important when children had difficulty accessing primary care or when traditional health care services were disrupted, eg, during the COVID-19 pandemic; and 3) workflow: vaccine-related workflow is often not standardized and lacks ownership.
    CONCLUSIONS: Despite variability in vaccine administration across children's hospitals, there are many common barriers and determinants. Solutions that address these barriers and meet the needs of multidisciplinary clinicians are essential to improve inpatient vaccine delivery.
    DOI:  https://doi.org/10.1542/peds.2025-075278
  22. JAMA Pediatr. 2026 Jun 22.
    Child Opportunity Index and Youth Mental Health Emergency Department Visits.
    Shelby Chesbro, Matthew Hall, Adrienne DePorre, Molly Krager, Laura Plencner, Shayla Sullivant, Henry T Puls.
       Importance: Youth mental health (MH) emergency department (ED) visits are increasing. Neighborhood opportunity may influence the prevalence of youth MH disorders and how frequently they seek MH care in an ED.
    Objective: To determine differences in rates of youth MH ED visits across zip code levels of neighborhood opportunity.
    Design, Setting, and Participants: This was a retrospective population-based cross-sectional study using the Hospital Industry Data Institute dataset, which provided all ED visit encounters that occurred at 254 nonpsychiatric acute care hospitals in Kansas and Missouri during federal fiscal years 2022 and 2023. Participants included youth aged 5 to 19 years in Kansas and Missouri. The American Community Survey provided population data. These data were analyzed from January to February 2024.
    Exposures: The primary exposure was zip code-level neighborhood opportunity, measured by the Child Opportunity Index 3.0 (COI), which is categorized into 5 levels for analysis and presentation. Covariates included state, rural and urban commuting areas, health professional shortage areas, age, sex, and year.
    Main Outcomes and Measures: Annual rates of ED visits with a primary MH diagnosis per 1000 youth. A multivariable Poisson regression model calculated adjusted rate ratios (aRR) and 95% CI after adjustment for covariates.
    Results: There were 52 362 MH ED visits among 1.79 million youth (57.5% female and 42.5% male) aged 5 to 19 years in Kansas and Missouri. Most of the visits occurred in Missouri (78.5%), in female patients (57.5%), in youth aged 15 to 19 years (57.8%), and in youth living in urban areas (69.5%). Rates of MH ED visits per 1000 youth decreased significantly as COI increased from 17.0 in zip codes with very low COI to 10.1 in zip codes with very high COI (17.0; 95% CI, 15.2-19.0; P < .001). In adjusted modeling, rates of MH ED visits were 1.74 times higher (95% CI, 1.54-1.98) in zip codes with very low COI relative to zip codes with very high COI (10.1; 95% CI, 9.0-11.4; P < .001).
    Conclusions and Relevance: In this study, youth living in lower opportunity zip codes had significantly greater rates of MH ED visits compared with youth in higher opportunity zip codes. Further investigation is necessary to examine causal mechanisms and to determine where additional resources should be directed to optimize youth MH well-being.
    DOI:  https://doi.org/10.1001/jamapediatrics.2026.2355
  23. Semin Roentgenol. 2026 Jun 25. pii: S0037-198X(26)00037-4. [Epub ahead of print]64 151005
    Rapid MRI for Pediatric Patients: Indications, Protocols, and High-Yield Diagnoses for Emergency Radiologists.
    Katherine N Epstein, Justine Kemp, Cara E Morin, Arthur B Meyers, Usha D Nagaraj, Gary R Schooler, Rama S Ayyala.
      Rapid MRI protocols are increasingly used in pediatric emergency imaging, providing fast, high-quality images without ionizing radiation, intravenous contrast, or sedation. These focused exams, using limited, optimized sequences, maintain diagnostic accuracy and can enhance patient flow in emergency settings. It is essential for radiologists to be familiar with key MR imaging findings of both common and rare pediatric emergency conditions, such as appendicitis, ovarian torsion, osteomyelitis, and childhood stroke. This article reviews the clinical indications and protocols for various rapid MRI exams and includes a case-based review of high-yield diagnoses.
    DOI:  https://doi.org/10.1016/j.ro.2026.151005
  24. Pediatr Clin North Am. 2026 Aug;pii: S0031-3955(26)00043-X. [Epub ahead of print]73(4): 833-841
    Insurance Hurdles for Laser Authorization in Pediatric Patients.
    Deepti Gupta.
      Laser procedures are safe and effective for various medical conditions in the pediatric population. Laser therapies are viewed as elective or cosmetic rather than medically necessary leading to their denial. Laser therapy can be deemed experimental or investigational, due to a lack of sufficient high-quality evidence showing that the treatment is safe, effective, and necessary for a medical condition. There is also lack of specific Current Procedural Terminology codes leading to the use of unlisted procedure codes that cause an increase in denials or initiation of prior authorizations. Overall, insurance coverage of laser procedures in pediatric patients is highly inconsistent.
    Keywords:  Coverage; Insurance; Laser; Medical necessity; Pediatric; Prior authorization
    DOI:  https://doi.org/10.1016/j.pcl.2026.03.011
  25. Emerg Med Clin North Am. 2026 Aug;pii: S0733-8627(26)00029-5. [Epub ahead of print]44(3): 555-566
    Hot or Not? Myths and Misconceptions About Antipyretics for Pediatric Fever.
    Dennis Ren, Damian Roland.
      Fever is one of the most common reasons for pediatric emergency visits, yet misconceptions continue to shape caregiver behavior and clinical practice. This review examines 5 common myths and misconceptions: (1) fever is harmful, (2) higher fever signals more severe illness, (3) antipyretics prevent febrile seizures, (4) clinical improvement after antipyretics rules out serious infection, and (5) alternating antipyretics is superior to monotherapy. Emergency medicine clinicians should prioritize distress-relieving care, careful assessment for serious illness, and effective caregiver education to reduce fever phobia and promote safe, evidence-based use of antipyretics.
    Keywords:  Antipyretics; Fever phobia; Misconceptions; Pediatric fever
    DOI:  https://doi.org/10.1016/j.emc.2026.03.003
  26. J Endocrinol Invest. 2026 Jun 24.
    Practical approach to the diagnosis, management, and treatment of pediatric patients with bone fragility: an expert opinion.
    Giampiero I Baroncelli, Daniele Tessaris, Tommaso Aversa, Enrica Bertelli, Pasquale Comberiati, Domenico Corica, Natascia Di Iorgi, Maria Felicia Faienza, Danilo Fintini, Roberto Franceschi, Anna Grandone, Mila Ann Karapurackal, Silvia Longhi, Marco Pitea, Andrea Secco, Giuliana Trifirò, Graziamaria Ubertini, Flavia Urbano, Francesco Vierucci, Malgorzata Wasniewska, Stefano Mora, Luisa de Sanctis.
       PURPOSE: Children and adolescents frequently experience fractures related to accidental injuries; however, fractures may also result from non-accidental trauma in abused children or from underlying bone fragility due to primary or secondary osteoporosis. In pediatric patients with fragility fractures diagnosis and treatment may be delayed. This document aims to provide clinicians with a practical approach to the diagnosis and management of fragility fractures in children and adolescents.
    METHODS: Between November 2024 and June 2025, a group of Italian pediatric endocrinologists with expertise in bone and mineral metabolism held regular online meetings to discuss key issues related to the diagnosis and management of pediatric bone fragility and developed experts opinion statements based on clinical experience and a review of the relevant literature.
    RESULTS: The expert panel formulated consensus statements on the clinical management of children and adolescents with fragility fractures. Seven main areas were addressed: 1) definition of fragility fractures and pediatric osteoporosis; 2) diagnostic approach; 3) main causes of primary and secondary osteoporosis; 4) assessment of the potential for spontaneous recovery from bone fragility; 5) management of bisphosphonate therapy; 6) other therapeutic options; 7) conservative measures.
    CONCLUSION: The diagnosis of osteoporosis in pediatric patients should follow a clinically oriented approach. Genetic testing plays a crucial role in identifying primary forms of osteoporosis. Vertebral reshaping may occur in some patients with secondary osteoporosis. Bisphosphonates represent the mainstay of treatment in children and adolescents with bone fragility. Conservative measures aimed at optimizing bone strength may be beneficial in selected cases.
    Keywords:  Adolescents; Bisphosphonates; Children; Fragility fractures; Osteoporosis; Vertebral reshaping
    DOI:  https://doi.org/10.1007/s40618-026-02882-8
  27. Am J Nurs. 2026 Jul 01. 126(7): 18
    Social media negatively affects children and adolescents.
    Karen Roush.
      
    DOI:  https://doi.org/10.1097/AJN.0000000000000339h
  28. JAMA Netw Open. 2026 Jun 01. 9(6): e2620122
    Needs and Perspectives on Upper Limb Prostheses Among Children and Adolescents With Upper Limb Differences.
    Kevin Wendo, Crystal Chigbu, Obafemi Ekundayo, Oluwaseun Ayodeji, Fiyinfoluwa Ayoola, Adebowale Adekemisola Ayoola, Gbolamide Ogunkua, Vindication Joseph, Gift Anyanwu, Séverine Guisset, Jade Ward, Benoît Herman, Stéphane Moniotte, Raphael Olszewski.
       Importance: In low- and middle-income countries (LMICs), limited access to adequate prosthetic care hinders the psycho-socio-motor development and educational progress of children and adolescents with upper limb differences. The suitability of current pediatric prosthetic solutions and the needs and expectations of children and adolescents with upper limb differences regarding upper limb prostheses (ULPs) remain understudied in LMICs.
    Objectives: To examine and characterize the needs, expectations, and perceptions of Nigerian children and adolescents with upper limb differences regarding ULPs, assessing contextualized specifications for prosthetic development.
    Design, Setting, and Participants: This qualitative study was conducted from July 20 to July 23, 2024, in Lagos, Nigeria, among 25 children and adolescents with upper limb differences purposively selected from The IREDE Foundation prosthetic care program; recipients were aged 5 through 20 years who possessed at least 1 ULP. This study involved semistructured interviews and focus groups of Nigerian children and adolescents with upper limb differences. Transcripts were analyzed using thematic analysis between August 2024 and May 2025.
    Main Outcomes and Measures: The needs and perceptions of children and adolescents with upper limb differences regarding ULPs.
    Results: A total of 25 children and adolescents with upper limb differences (mean [SD] age, 13.5 [4.2] years; 15 male [60%]) enrolled in the study; 14 were interviewed, and 11 engaged in focus groups. The predominant cause of upper limb differences was traumatic amputations (16 [64%]), and the predominant level of upper limb differences was transhumeral (16 [64%]). Seven themes were identified from the interviews and focus groups. First, the children and adolescents with upper limb differences described the technical specifications of an ideal ULP by (1) highlighting the functionalities and task performance it should enable; (2) expressing their need for an active ULP and the characteristics of effective terminal devices; (3) specifying user-defined requirements for quality of prostheses components; (4) describing factors contributing to comfortable wear and use; and (5) explaining the necessity for anthropomorphism (shape and color) of ULP designs. Second, the psychosocial consequences of the conditions of the children and adolescents with upper limb differences and ULP use emerged: adverse repercussions (6) on self-concept and (7) in interactions with their social network, which were major factors in ULP acceptance. Overall, children and adolescents with upper limb differences expressed the need for an active, anthropomorphic, sturdy ULP, enabling them to actively engage with their peers.
    Conclusions and Relevance: In this qualitative study, children and adolescents with upper limb differences expressed perceptions regarding their current ULP and described the requirements of prosthetic devices meeting the psychosocial and occupational needs within their socialcultural environment. Future studies could incorporate these findings into the development of environment-specific pediatric ULPs.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.20122
  29. Children (Basel). 2026 Jun 02. pii: 775. [Epub ahead of print]13(6):
    Universal Autism Screening in Early Learning Programs: A Feasibility Study.
    Thyde Dumont-Mathieu, Marianne Barton, Rosalie Chuckta, Natalia Suarez Martinez, Deborah Fein.
      Background: The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child-care visits. Early identification facilitates early intervention (EI), which improves developmental outcomes. Historically, Non-Hispanic Black and Hispanic/Latino children in the United States receive autism diagnoses and autism-specific services later than Non-Hispanic White children. Variability in pediatric screening rates may indicate that systemic factors impede screening and referral; enhanced screening across community settings may support autism identification and connection to services. Methods: A feasibility study was conducted with one early learning program (ELP) to determine if screening for autism in ELPs is feasible. ELP teachers and staff received one 90 min training session on screening with the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). They were then tasked with independently screening ELP-enrolled children between 16 and 30 months old. Results: Eighty children were eligible for screening and 79 screenings were completed; 14 screens were positive and 65 were negative. Of the 14 positive screens, eight referrals were made to EI. All eight families completed EI evaluations and were eligible for EI services. One family declined an evaluation. Five positive autism screens were for children already receiving general EI services. Those five screening results were communicated to the child's EI team and an autism-specific evaluation was completed; four of the five children subsequently received autism diagnoses. Conclusions: Our data supports the feasibility of completing autism-specific screenings within an ELP setting.
    Keywords:  autism spectrum disorder; developmental conditions; early intervention; early learning program; universal screening
    DOI:  https://doi.org/10.3390/children13060775
  30. Pediatr Clin North Am. 2026 Aug;pii: S0031-3955(26)00038-6. [Epub ahead of print]73(4): 857-866
    Inequitable Reimbursement for Pediatric Providers: A Review of Structural Factors that Disincentivize the Care of Children.
    Jaclyn Daigneault, Heli Patel, Robert J Smith.
      Pediatricians and pediatric subspecialists receive lower rates of compensation than their colleagues who care for adult patients. Systemic financial structures within the American health care system disincentivize both individual providers and larger health care systems from investing in pediatric care. The disproportionate overvaluation of procedural care over cognitive care in our Relative Value Unit designation structure encourages systems to focus their care energies on adult patients. In addition, the primary insurer of pediatric patients, Medicaid, systematically reimburses at lower rates than Medicare and commercial insurances.
    Keywords:  Medicaid; Pediatric dermatology; Reimbursement disparities; Relative value unit
    DOI:  https://doi.org/10.1016/j.pcl.2026.03.006
  31. BMC Public Health. 2026 Jun 24.
    Unintentional ingestion of recreational drugs among young children, 2000-2024.
    Kristen Uskovich, Hannah L Hays, Jaahnavi Badeti, Natalie I Rine, Nichole L Michaels, Kele Ding, Gary A Smith.
       BACKGROUND: Previous studies of pediatric recreational drug exposures have often been limited in scope. Given the rapidly changing recreational drug supply and the related unintentional ingestion of these drugs by young children, a comprehensive study that includes recent data about these exposures is needed. The objective of this study is to investigate the characteristics and trends of unintentional ingestions of recreational drugs by children < 6 years old.
    METHODS: Using a retrospective cohort study design, National Poison Data System data from 2000 to 2024 were analyzed. United States Census Bureau data were used to calculate population-based ingestion rates. Rate ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the magnitude of relationships between key characteristics and outcomes, such as highest level of health care received and medical outcome.
    RESULTS: There were 41,612 unintentional ingestions involving recreational drugs among children < 6 years old reported to United States poison centers from 2000 to 2024. Most were among children < 3 years old (57.6%), involved a single substance (95.9%), and occurred in a residence (96.4%). Although 50.6% of children experienced no or minor effects, 5.0% had a major effect and there were six deaths. Children < 3 years old were more likely to experience a major effect (RR: 1.54; 95% CI:1.39-1.71) or be admitted to a critical care unit (RR: 1.23; 95% CI: 1.16-1.30) than children 3-5 years old. Cannabinoids accounted for 84.7% of ingestions, followed by stimulants (8.4%), psychedelics (3.5%), opioids (2.8%), and dissociative agents (0.6%). Ingestions involving opioids (RR: 2.60; 95% CI: 2.36-2.86), stimulants (RR: 2.16; 95% CI: 2.01-2.31), and dissociative agents (RR: 1.59; 95% CI: 1.23-2.06) were more likely to be admitted to a critical care unit than the other substance categories combined. The recreational drug ingestion rate per 100,000 US children < 6 years old increased 3,307% from 1.05 in 2000 to 35.91 in 2024, with a rapid increase beginning in 2013, especially involving edible marijuana and psilocybin products.
    CONCLUSIONS: The recreational drug ingestion rate among children < 6 years old reported to United States poison centers increased substantially from 2000 to 2024. Additional efforts are needed to prevent these unintentional ingestions in this vulnerable population.
    Keywords:  Pediatric; Poison; Recreational drugs; Toxicity
    DOI:  https://doi.org/10.1186/s12889-026-28233-z
  32. J Asthma Allergy. 2026 ;19 605374
    Implementation of an Institutional Asthma Care Guideline in Hospitalized Children: Effects on Clinical Outcomes and Healthcare Resource Utilization.
    Supawadee Intusup, Kanokpan Ruangnapa, Wanaporn Anuntaseree, Kantara Saelim, Pharsai Prasertsan, Kantisa Sirianansopa.
       Background: Acute asthma exacerbations are a major cause of pediatric hospitalization and healthcare utilization. Despite the availability of standard guidelines, variability in inpatient management persists and may affect both clinical outcomes and resource use.
    Objective: To evaluate the impact of an institutional inpatient asthma care guideline on treatment processes, clinical outcomes, and hospitalization costs in children.
    Methods: This retrospective quality improvement cohort study included children aged 1-15 years hospitalized for acute asthma between 2016 and 2024. Patients were categorized into three phases: pre-implementation, post-implementation, and post-revision. The institutional guideline standardized bronchodilator escalation, respiratory support, and discharge planning, and was implemented using Plan-Do-Study-Act (PDSA) cycles.
    Results: A total of 220 children were included. Compared across the three phases, time to first bronchodilator decreased significantly (117 vs 104 vs 70 minutes, P < 0.001), with increased use of selected interventions, including nebulized steroids and high-flow nasal cannula (both P < 0.001). Differences in 24-hour clinical respiratory score reduction were observed across study phases, with adjusted analyses demonstrating greater improvement following guideline implementation. However, resource utilization increased after implementation, with longer hospital length of stay (47.5 vs 58.6 vs 67.3 h, P = 0.004) and higher hospitalization costs (249.7 vs 460.6 vs 447.0 USD, P < 0.001).
    Conclusion: Implementation of an institutional asthma care guideline was associated with improved treatment timeliness and early clinical improvement but was also associated with increased length of stay and hospitalization costs, suggesting a trade-off between clinical management and resource utilization.
    Keywords:  acute asthma; clinical practice guideline; inpatient management; pediatric; pre–post intervention study
    DOI:  https://doi.org/10.2147/JAA.S605374
  33. J Surg Res. 2026 Jun 20. pii: S0022-4804(26)00330-6. [Epub ahead of print]325 154-160
    A Budding Problem: A 20-Year National Analysis of Pediatric Earbud Injuries.
    Seth J Weir, Jermaine Robertson, Yoli L Meydan, Phoebe K Lawrence, Kenneth W Gow, Kristen Calabro, Helen Hsieh, Jaime P Doody.
       INTRODUCTION: While pediatric ear foreign bodies are well described, injuries related to headphone earbud use have not been reported. As earbuds (and especially wireless ones) continue to increase in popularity, understanding the risks associated with earbud use becomes increasingly important.
    METHODS: We conducted a retrospective review of earbud-related injuries in patients ≤21 y using the National Electronic Injury Surveillance System from January 1, 2005, to December 31, 2024. Cases were identified with keyword search terms. Manual review of narratives was used to identify presenting complaints and associated symptoms.
    RESULTS: We identified 784 earbud-related cases, representing a national estimate of approximately 27,893 cases. Interestingly, cases increased significantly over time (4.2 cases/year; R2 = 0.85; P < 0.001). Ninety-eight percent of children were treated in the emergency department and discharged home. The most common presenting complaint was ear foreign body (61%), followed by nasal foreign body (13%) and swallowed foreign body (8%). Age-related differences were significant for both involved anatomical site and mechanism of injury (P < 0.001). Younger children (≤7) were more likely to swallow earbuds or insert them into the nose, while older children were more likely to sustain injuries from inserting them into the ear.
    CONCLUSIONS: Earbud-related injuries in children have increased significantly over the last 20 y. Younger children are more likely to ingest earbuds or insert them into their noses, whereas older children are more likely to experience ear injuries. These findings may reduce preventable harm through improved product design, age-specific safety precautions, and expanded education.
    Keywords:  Earbud; Injury; Pediatric
    DOI:  https://doi.org/10.1016/j.jss.2026.05.038
  34. J Pediatr Orthop. 2026 Jun 01.
    Operative Treatment Versus Spica Casting for Treatment of Pediatric Femoral Shaft Fractures in Children Aged 4 to 6 Years: A Large Multi-Institutional Age-Stratified Comparative Analysis.
    Yamen Abbas, Travis Kotzur, Muhammad-Amin Munshi, Blaire Peterson VanderWeele, Javad Shariati, Mahara Mohseni, Pooya Hosseinzadeh.
       BACKGROUND: Femoral shaft fractures in children aged 4 to 6 years represent a clinical gray zone between closed reduction with casting and operative treatment. Traditional guidance favors closed treatment under age 6, yet recent reports suggest increasing use of operative treatment despite limited evidence. This study characterized national treatment rates from 2013 to 2024 and compared health care utilization outcomes.
    METHODS: This retrospective cohort study used the TriNetX Research Network, a federated platform containing nationwide deidentified health records. Patients from 2013 to 2024 with femoral shaft fractures were identified through ICD codes. Data on closed versus operative treatment (defined by CPT codes), sex, race, and ethnicity were extracted. Annual treatment rates, both total and age-stratified, were calculated. Logistic regression and Rao & Scott adjusted χ2 testing with Bonferroni correction were performed. Propensity score matching was performed for the combined 4- to 6-year cohort; age-stratified analyses were unmatched.
    RESULTS: A total of 2486 children aged 4 to 6 years with femoral shaft fractures were identified; 47.3% underwent operative treatment. The proportion treated with closed reduction and spica casting decreased overall, most notably among children aged 5 years (64.3% to 30.6%) and 6 years (51.4% to 23.7%), while rates remained stable at age 4 (67.4% to 77.8%). In the matched combined cohort, operative treatment was associated with fewer early emergency department visits (RR: 0.64; 95% CI: 0.42-0.97), more late postreduction procedures (RR: 4.20; 95% CI: 2.77-6.37), and more routine healing visits (RR: 1.76; 95% CI: 1.45-2.13). Differences were most pronounced at age 6 in unmatched analyses (early ED visits-OR: 0.32; 95% CI: 0.19-0.51; early postreduction procedures-OR: 0.23; 95% CI: 0.12-0.42).
    CONCLUSIONS: The rate of operative management of femoral shaft fractures increased by 94% at age 5 and by 61% at age 6 during the study period, despite limited age-specific evidence supporting this shift. This change likely reflects multiple factors, including growing surgeon familiarity with minimally invasive fixation, family-centered considerations, and age-dependent challenges of spica casting, rather than evidence of clinical superiority.
    LEVEL OF EVIDENCE: Level III-therapeutic study (retrospective comparative study).
    Keywords:  TriNetX; emergency department utilization; femoral shaft fracture; hip spica casting; implant removal; operative fixation; pediatric femur fracture; treatment trends
    DOI:  https://doi.org/10.1097/BPO.0000000000003362
  35. Cureus. 2026 May;18(5): e109304
    Clinical Characteristics and Associated Comorbidities in Children and Adolescents With Type 1 Diabetes Mellitus: A Retrospective Study.
    Salman Almansour.
       OBJECTIVE: Type 1 diabetes mellitus (T1DM) in pediatric and adolescent populations is correlated with significant metabolic instability and an elevated risk of autoimmune and metabolic comorbidities, which can negatively impact long-term health outcomes. Notwithstanding the increasing prevalence of pediatric T1DM in Saudi Arabia, there is a paucity of region-specific evidence delineating the clinical profiles and associated comorbid conditions within this demographic. This study aimed to evaluate the clinical features and comorbidities among children and adolescents with T1DM.
    METHODS: This retrospective analysis was conducted from March 2020 to February 2023 at the Pediatrics Department of King Saud Hospital in Unaizah, Qassim region, Saudi Arabia. The study included Saudi children aged two to 17 years diagnosed with T1DM. Sociodemographic, anthropometric, and laboratory data were extracted. Data were analyzed using SPSS v22 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used, along with paired-samples t-tests to assess changes in glycated hemoglobin (HbA1c) and chi-square tests to examine associations between variables.
    RESULTS: This study included 407 children and adolescents with T1DM. There were 211 males (51.8%) and 196 females (48.2%). The mean age was 12.27±4.54 years, with a mean age at diagnosis of 7.92±3.94 years. Poor glycemic control at diagnosis (HbA1c ≥ 9%) was observed in 288/370 patients (77.8%), which decreased to 222/375 patients (59.2%) at final follow-up, with a mean HbA1c reduction of 0.83%. A family history of T1DM was noted in 50/131 patients (38.2%), and type 2 diabetes in 83/121 patients (68.6%). The prevalence of poor glycemic control (HbA1c ≥9%) differed significantly across age groups, with higher rates observed among adolescents aged 10-15 years (67.6%) and ≥15 years (64.9%) compared with children aged <10 years (36.3%) (p<0.001).
    CONCLUSION: Children and adolescents with T1DM were found to have poor glycemic control and a high rate of autoimmune and metabolic comorbidities, particularly thyroid dysfunction, dyslipidemia, and vitamin D deficiency. These findings highlight the need for systematic screening and comprehensive clinical monitoring in pediatric populations with T1DM.
    Keywords:  comorbidities; glycemic control; pediatrics; saudi arabia; type 1 diabetes mellitus
    DOI:  https://doi.org/10.7759/cureus.109304
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