Design  Cross-sectional sample.

Setting  Urban primary care clinic.

Participants  Healthy infants and toddlers (N = 380) who were seen for a routine health visit.

Outcome Measures  Primary outcomes were serum 25OHD and parathyroid hormone levels; secondary measures included data on sun exposure, nutrition, skin pigmentation, and parental health habits. Wrist and knee radiographs were obtained for vitamin D–deficient participants.

Results  The prevalence of vitamin D deficiency (≤20 ng/mL) was 12.1% (44 of 365 participants), and 146 participants (40.0%) had levels below an accepted optimal threshold (≤30 ng/mL). The prevalence did not vary between infants and toddlers or by skin pigmentation. There was an inverse correlation between serum 25OHD and parathyroid hormone levels (infants: r  = –0.27, P < .001; toddlers: r = –0.20, P = .02). In multivariable models, breastfeeding without supplementation among infants and lower milk intake among toddlers were significant predictors of vitamin D deficiency. In vitamin D–deficient participants, 3 participants (7.5%) exhibited rachitic changes on radiographs, whereas 13 (32.5%) had evidence of demineralization.

Conclusions  Suboptimal vitamin D status is common among otherwise healthy young children. Predictors of vitamin D status vary in infants vs toddlers, information that is important to consider in the care of these young patients. One-third of vitamin D–deficient participants exhibited demineralization, highlighting the deleterious skeletal effects of this condition.

Data Sources  Articles were identified by searching MEDLINE using 25-hydroxyvitamin D, vitamin D, hypovitaminosis D, vitamin D insufficiency, vitamin D deficiency, children, and adolescents as key words and by screening references from original studies.

Study Selection  Studies were included if they fulfilled the following a priori criteria: contained a well-defined sample of children, included only healthy children, presented data on serum 25-hydroxyvitamin D concentrations, were published in the past 10 years, and were conducted in the United States.

Data Extraction  Serum 25-hydroxyvitamin D concentrations and prevalence of low vitamin D status (hypovitaminosis D).

Data Synthesis  Fourteen articles fulfilled the criteria. There were no consistent definitions of hypovitaminosis D; values corresponding to vitamin D deficiency ranged from less than 5 ng/mL to less than 12 ng/mL, and those for vitamin D insufficiency ranged from less than 10 ng/mL to less than 32 ng/mL (to convert 25-hydroxyvitamin D concentrations to nanomoles per liter, multiply by 2.496). The following assays were used: radioimmunoassay (7 studies), competitive binding protein assay (3 studies), automated chemiluminescence protein-binding assay (3 studies), and enzyme-linked immunosorbent assay (1 study). Breastfed infants in winter who did not receive vitamin D supplementation were the most severely vitamin D deficient (78%). Estimates of the prevalence of hypovitaminosis D ranged from 1% to 78%. Older age, winter season, higher body mass index, black race/ethnicity, and elevated parathyroid hormone concentrations were associated with lower 25-hydroxyvitamin D concentrations.

Conclusion  Although overt vitamin D deficiency is no longer common in US children, lesser degrees of vitamin D insufficiency are widespread.

Design  Retrospective case-control study.

Setting  Endocrine Gynecology Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada.

Patients  Girls and young women aged 14 to 18 years having PA and PCOS (n = 9) seen during a 21/2-year period were compared with control subjects having OM/SA and PCOS (n = 18) randomly selected during the same period.

Intervention  Medical record review was performed to assess clinical, biochemical, and ultrasonographic measures, as well as response to a progesterone challenge.

Main Outcome Measures  Differences in response to the progesterone challenge, hyperandrogenism, and the presence of features of the metabolic syndrome.

Results  Compared with adolescents having OM/SA, adolescents having PA demonstrated older age at pubarche, higher androstenedione levels, greater prevalence of family history of obesity, a tendency toward no withdrawal bleeding in response to the progesterone challenge, and more features associated with the metabolic syndrome (acanthosis nigricans, higher diastolic blood pressure, and lower high-density lipoprotein cholesterol level). No significant correlation was demonstrated between response to the progesterone challenge, metabolic features, and androstenedione levels.

Conclusion  Adolescents with PA and PCOS exhibit increased features of the metabolic syndrome and higher androstenedione levels and may represent a more severe spectrum of a common condition.

Design  We conducted a retrospective study among children and adolescents affected by JAT.

Settings  Data from 6 Italian pediatric endocrinology centers were collected.

Participants  Three hundred sixty-five children and adolescents affected by JAT diagnosed at 3.6 to 17.0 years of age.

Interventions  All patients underwent clinical examination and thyroid function test every 6 to 12 months and thyroid echography every 12 to 24 months. Fine-needle aspiration biopsy was performed in 39 patients with nodule diameter of 1 cm or larger, as well as in 4 patients with nodule diameter of less than 1 cm and echographic findings suspicious for neoplasm. Twenty-three patients underwent surgery.

Main Outcome Measures  Thyroid function, echographic pattern, nodule diameter, the presence of lymphadenopathy, and cytologic and histologic diagnoses were considered.

Results  Thyroid nodules were found in 115 patients; findings in 11 of these were consistent with papillary carcinoma, with 5 exhibiting lymph node metastasis. The prevalence of male sex among patients with cancer was greater than that among patients with JAT (odds ratio [OR], 2.95; 95% confidence interval [CI], 1.44-6.20). The growth of nodules during levothyroxine sodium therapy (OR, 15.60; 95% CI, 1.87-181.90) and the finding of lymphadenopathy (OR, 5.44; 95% CI, 1.05-30.50) were statistically significantly associated with the presence of cancer, while uninodularity and hypoechogenicity were not.

Conclusions  The observed prevalences of thyroid nodules and thyroid cancer in our JAT case series were 31.5% and 3.0%, respectively. Papillary carcinoma was the only histotype detected. The finding of lymphadenopathy, a lack of response to levothyroxine therapy, and nodule hypoechogenicity suggested malignancy. Fine-needle aspiration biopsy was reliable in selecting patients for referral to surgery.

Design  Anonymous questionnaire.

Setting  Four province of Quebec, Canada, university centers.

Participants  A total of 165 pediatric and obstetric residents.

Interventions  Survey of attitudes about resuscitation of neonates born between 23 and 27 weeks of gestation, and knowledge of the prevalence of cerebral palsy in survivors.

Main Outcome Measures  Proportion of residents who would resuscitate a depressed, very preterm infant, and the proportion who overestimated the prevalence of cerebral palsy.

Results  The percentage of residents who would resuscitate a depressed infant born at 24 weeks varied from 11% to 39% between centers, at 25 weeks between 26% and 69%, and at 26 weeks between 51% and 86%. At the center most likely to intervene for very immature infants, the greatest proportion of residents favored resuscitation at each gestational age. At the least interventionist center, the smallest proportion would resuscitate. The center of training was the only factor related to willingness to resuscitate at 24, 25, 26, and 27 weeks of gestation; not age, years of training, religion, sex, or parental status (whether the person surveyed has children). A total of 53% of residents thought the prevalence of cerebral palsy was 25% or 40% in this population. Residents with a more accurate knowledge of outcome were more likely to want to resuscitate very immature infants.

Conclusion  Different treatment centers may develop their own ethos regarding resuscitation, which then shapes both the way the residents understand epidemiological data and how they make decisions.

Design  Retrospective cohort study.

Setting  Physician reimbursement administrative data were obtained for all children aged 16 years or younger in the Province of Québec (Canada).

Participants  Suspected new-onset cases of JRA in 2000 were defined by a physician visit because of JRA, providing there had been no such claims in the preceding 3 years.

Main Exposure  First JRA diagnosis made by a non–arthritis specialist.

Main Outcome Measures  First consultation with an arthritis specialist subsequent to diagnosis by a non–arthritis specialist and time to first consultation with an arthritis specialist.

Results  Of 352 children and adolescents with suspected new-onset JRA identified by non–arthritis specialists, 159 (45.2%) were subsequently seen by an arthritis specialist. Mean (SD) time to consultation for those seen was 115.3 (213.8) days (median, 28 days). Younger children were more likely to obtain care from an arthritis specialist compared with those having JRA first diagnosed by a general practitioner.

Conclusion  Most patients with suspected new-onset JRA do not obtain prompt care from an arthritis specialist. Further research and action should focus on this issue so that outcomes may be optimized.

Design  For this observational study, we performed electrocardiography during DKA and after recovery. We measured QTc as the QT interval divided by the square root of the R-R interval and correlated QTc with clinical variables.

Setting  The pediatric emergency department and intensive care unit of an academic medical center.

Patients  Thirty children with type 1 diabetes mellitus and DKA.

Main Outcome Measure  The QTc during DKA.

Results  The mean (SD) QTc during DKA was 450 (38) milliseconds (range, 378-539 milliseconds). After recovery from DKA, the mean (SD) QTc decreased to 407 (36) milliseconds (range, 302-485 milliseconds; difference, 43 milliseconds; 95% confidence interval, 23-63 milliseconds) (P < .001). Fourteen of the 30 children (47%) had prolonged QTc during DKA (range, 450-539 milliseconds). After recovery from DKA, only 4 children (13%) had persistent QTc prolongation (range, 451-485 milliseconds). The anion gap was significantly associated with QTc prolongation (correlation coefficient, 0.49; P = .006). Most patients had no electrolyte abnormalities or hypoglycemia to account for QTc prolongation.

Conclusions  Prolonged QTc occurs frequently during DKA and is correlated with ketosis. Current guidelines regarding cardiac monitoring of children during DKA should be strictly followed, and electrocardiographic screening of patients with other ketotic conditions should be considered.

Design  Prospective cohort study.

Setting  National Survey of Child and Adolescent Well-Being, October 1999 to March 2004.

Participants  One thousand three hundred nine children entering out-of-home care following a maltreatment report.

Main Exposure  Kinship vs general foster care.

Main Outcome Measures  Predicted probabilities of behavioral problems derived from Child Behavior Checklist scores.

Results  Fifty percent of children started in kinship care and 17% of children who started in foster care later moved to kinship care. Children in kinship care were at lower risk at baseline and less likely to have unstable placements than children in foster care. Controlling for a child's baseline risk, placement stability, and attempted reunification to birth family, the estimate of behavioral problems at 36 months was 32% (95% confidence interval, 25%-38%) if children in the cohort were assigned to early kinship care and 46% (95% confidence interval, 41%-52%) if children were assigned to foster care only (P = .003). Children who moved to kinship care after a significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset.

Conclusions  Children placed into kinship care had fewer behavioral problems 3 years after placement than children who were placed into foster care. This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care.

Published online June 2, 2008 (doi:10.1001/archpedi.162.6.550).

Design  Cross-sectional study.

Setting  Secondary analysis of the 1999-2002 National Health and Nutrition Examination Survey data.

Participants  Children 2 to 11 years of age (N = 3618).

Main Exposure  Juice consumption.

Outcome Measures  The association between juice consumption, nutrient intake, food group consumption, and weight status was determined as was the likelihood of overweight with juice consumption.

Results  Mean daily juice consumption was 4.1 fl oz, which contributed a mean intake of 58 kcal (3.3% of total energy intake). Compared with nonconsumers, the overall nutritional profile of those consuming 100% juice had significantly higher intakes of energy, carbohydrates, vitamins C and B₆, potassium, riboflavin, magnesium, iron, and folate and significantly lower intakes of total fat, saturated fatty acids, discretionary fat, and added sugar. Children consuming 100% juice also consumed significantly more servings of total whole fruit than nonconsumers. No significant differences were found in weight status and the amounts of 100% juice consumed. There was no difference in the likelihood of being overweight between juice consumers and nonconsumers.

Conclusions  On average, children consumed less than the maximum amounts of 100% juice recommended by the American Academy of Pediatrics. One hundred percent juice consumption was associated with better nutrient intake than in the nonconsumption group and was not associated with weight status or the likelihood of being overweight in children 2 to 11 years of age.

Design  Cross-sectional study.

Setting  Secondary schools in Sydney.

Participants  Grade 10 students (N = 496; 58.4% boys; mean [SD] age, 15.4 [0.4] years).

Main Exposures  Height, weight, waist circumference, blood pressure, and fasting blood samples.

Outcome Measures  Participants were categorized as overweight or obese using the International Obesity Task Force cut points and the UK waist circumference cut points. Blood was analyzed for high- and low-density lipoprotein cholesterol, triglycerides, insulin, glucose, alanine aminotransferase, -glutamyltransferase, and high-sensitivity C-reactive protein levels, and the results were categorized as normal or abnormal according to published guidelines where possible. Associations between overweight and obesity and risk factors were explored using logistic regression. Clustering of risk factors within individuals was also explored.

Results  Insulin (P < .001), alanine aminotransferase (P < .001), -glutamyltransferase (P = .005), high-density lipoprotein cholesterol (P < .001), high-sensitivity C-reactive protein (P < .001), and blood pressure (P < .001) were significantly associated with overweight and obesity in adolescent boys. In adolescent girls, insulin, high-density lipoprotein cholesterol (P < .001), and high-sensitivity C-reactive protein (P < .001) were significantly associated with overweight and obesity. Obese adolescent boys and girls were significantly more likely to have 2 or more risk factors (boys: 73.5% vs 7.6%; girls: 44.4% vs 5.4%; P < .001 for both) than nonoverweight adolescents.

Conclusions  Overweight and obese adolescents, especially boys, are at substantial risk for chronic conditions. Waist circumference is not a better predictor of metabolic risk factors than is body mass index.

Design  Prospective cohort study.

Setting  Self-report questionnaires.

Subjects  Girls (n = 6916) and boys (n = 5618), aged 9 to 15 years at baseline, in the ongoing Growing Up Today Study (GUTS).

Main Exposures  Parent, peer, and media influences.

Main Outcome Measures  Onset of starting to binge eat or purge (ie, vomiting or using laxatives) at least weekly.

Results  During 7 years of follow-up, 4.3% of female subjects and 2.3% of male subjects (hereafter referred to as "females" and "males") started to binge eat and 5.3% of females and 0.8% of males started to purge to control their weight. Few participants started to both binge eat and purge. Rates and risk factors varied by sex and age group (<14 vs ≥14 years). Females younger than 14 years whose mothers had a history of an eating disorder were nearly 3 times more likely than their peers to start purging at least weekly (odds ratio, 2.8; 95% confidence interval, 1.3-5.9); however, maternal history of an eating disorder was unrelated to risk of starting to binge eat or purge in older adolescent females. Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly.

Conclusions  Risk factors for the development of binge eating and purging differ by sex and by age group in females. Maternal history of an eating disorder is a risk factor only in younger adolescent females.

Design  A population-based study.

Setting  Bereaved families were recruited through the coroner's records and by advertisement. Control families were recruited by random-digit dialing and advertisement.

Participants  Families with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n = 140). Controls (n = 99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years.

Main Outcome Measures  Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers.

Results  Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3-7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death.

Conclusions  Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers.

Design  Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development.

Setting  Urban public hospital.

Participants  Low socioeconomic status mothers of 6-month-old infants.

Main Exposure  Media exposure and content.

Main Outcome Measures  Mother-infant verbal interaction associated with media exposure and maternal coviewing.

Results  Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child–oriented media (42.8% of programs), compared with 21.3% of noneducational young child–oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult–oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child–oriented programs.

Conclusions  We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions.

Design  We examined whether adopted and nonadopted adolescents differed on quantitative indicators of mental health and the prevalence of childhood disorders and whether differences exist between internationally and domestically placed adoptees.

Setting  Assessments occurred at the University of Minnesota from December 11, 1998, to June 4, 2004.

Participants  Adolescents adopted in infancy were systematically ascertained from records of 3 large Minnesota adoption agencies; nonadopted adolescents were ascertained from Minnesota birth records. The final sample included these adolescents with their rearing parents.

Main Exposure  The main exposure was adoptive status: nonadopted (n = 540), international adoptive placement (n = 514), or domestic adoptive placement (n = 178).

Outcome Measures  Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) clinical assessments based on child and parent reports of attention-deficit/hyperactivity, oppositional defiant, conduct, major depressive, and separation anxiety disorders; teacher reports of psychological health; and contact with mental health professionals.

Results  Adoptees scored only moderately higher than nonadoptees on quantitative measures of mental health. Nevertheless, being adopted approximately doubled the odds of having contact with a mental health professional (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.48-2.84) and of having a disruptive behavior disorder (OR, 2.34; 95% CI, 1.72-3.19). Relative to international adoptees, domestic adoptees had higher odds of having an externalizing disorder (OR, 2.60; 95% CI, 1.67-4.04).

Conclusions  Moderate mean differences in quantitative indicators of mental health can lead to substantial differences in disorder prevalence. Although most adopted adolescents are psychologically healthy, they may be at elevated risk for some externalizing disorders, especially among those domestically placed.

Design  A multisite, cross-sectional study using data from medical records and public health logs to categorize and define use of routine prevention practices in managing pediatric TB and LTBI.

Setting  Four areas of the United States.

Participants  Children younger than 5 years diagnosed with TB from January 1, 2002, through December 31, 2004, and children with LTBI reported during a continuous 12-month period in 2003 to 2004.

Main Exposure  Mycobacterium tuberculosis.

Main Outcome Measures  Underuse or nonuse of standard medical and public health interventions.

Results  Almost 40% of children had a TB risk factor related to their country of birth, parental origin, or travel to a country with a high incidence of TB. Children having LTBI were less likely than those having TB to complete treatment (53.7% vs 88.6%, respectively). Almost half (46.3%) of the children with TB came to medical attention late in their course when they already had symptoms. Among 63 adult source patients, 19 (30.2%) previously had LTBI but were not treated, and none of the 40 foreign-born source patients were known to have been evaluated for TB before entry into the United States.

Conclusions  Prevention efforts are unsatisfactory to prevent TB in children. Effective interventions such as treatment of LTBI and TB evaluation of adult immigrants remain less than optimal.

Design  Only data from baseline, before randomization, were used for this analysis.

Setting  A clinic-based sample of young females enrolled in a randomized trial of an HIV-prevention program in Atlanta, Georgia, from March 2002 to August 2004.

Participants  African American females aged 15 to 21 years who reported sexual activity in the previous 60 days. Of 1558 screened, 874 females were eligible and 82% (n = 715) participated at baseline.

Outcome Measures  History of sexual violence as well as (1) sexual partner communication skills, (2) current sexual behaviors, and (3) psychological well-being.

Results  Lifetime prevalence of sexual violence was 26%. Communication skills partially mediated the relationship between sexual violence and psychological well-being and sexual behavior outcomes.

Conclusions  Given the lifetime prevalence of sexual violence and its adverse sexual, psychological, and relational sequelae, it is paramount that effective interventions are developed. Based on our findings, improving partner communications skills is one particularly important area for HIV/sexually transmitted disease risk–reduction interventions for youths with a history of sexual violence.

Design  Prospective observational study.

Setting  Four level I pediatric trauma centers.

Participants  One thousand patients younger than 21 years with minor head trauma undergoing cranial CT.

Main Outcome Measure  Intracranial injury as demonstrated by CT and neurosurgical intervention.

Results  Of 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%).

Conclusions  We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.

Main Exposure  Many children exposed to potentially traumatic events develop severe and long-lasting negative somatic and psychological problems. Pediatric providers are often ideally situated to detect children with these symptoms, provide office-based interventions, and make referrals to optimal community treatment providers.

Main Outcome Measures  Several comprehensive literature reviews of evidence-based treatments for traumatized children conducted by other organizations were evaluated and summarized for their relevance to primary care pediatricians.

Results  Optimal pediatric screening and office-based interventions for traumatized children are described. Evidence-based practices for traumatized children are summarized and their common treatment elements extracted. Suggestions for engaging families in mental health care referrals are included.

Conclusions  Pediatric providers can identify and provide office-based interventions for traumatized children as well as play a critical role in referring children for optimal mental health treatments.

Design  Cross-sectional study of a population-based cohort.

Setting  Saguenay Youth Study, Quebec, Canada.

Participants  A total of 324 adolescents, aged 12 to 18 years.

Intervention  Measures were compared between males and females with "high" or "low" intra-abdominal fat (IAF).

Main Outcome Measures  Intra-abdominal fat was quantified with magnetic resonance imaging. Primary outcome measures were blood pressure (BP) and fasting serum glucose, insulin, lipids, and C-reactive protein levels. Secondary mechanistic measures were cardiovascular variability indexes of autonomic nervous system function, pubertal development, and serum levels of cortisol, leptin, and sex hormones.

Results  The MS was completely absent in adolescents with low IAF and was present in 13.8% of males and 8.3% of females with high IAF. Excess IAF was associated with a higher homeostasis model assessment index (0.5 [95% confidence interval (CI), 0.3 to 0.8]; P < .001) and triglycerides level (17.7 mg/dL [to convert to millimoles per liter, multiply by 0.0113] [95% CI, 9.7 to 25.7 mg/dL]; P < .001), lower high-density lipoprotein cholesterol level (–3.9 mg/dL [to convert to millimoles per liter, multiply by 0.0259] [95% CI, –6.2 to –1.5 mg/dL]; P = .003), and higher C-reactive protein level (0.03 mg/L [to convert to nanomoles per liter, multiply by 9.524] [95% CI, 0.01 to 0.05 mg/L]; P = .003). High IAF was associated with elevations of BP and sympathetic activity in males only (higher systolic BP, 6 mm Hg [95% CI, 1 to 11 mm Hg]; P = .02 and low-frequency power of diastolic BP, 629 mm Hg² [95% CI, 37 to 1222 mm Hg²]; P = .04).

Conclusions  Our results suggest that, already in adolescence, accumulation of IAF may promote development of the MS, affecting the metabolic and inflammatory components similarly in both sexes but influencing BP adversely only in males. The latter may be attributed, in part, to the augmentation of sympathetic activity also seen only in males.

Design  Cross-sectional study.

Participants  A total of 416 Spanish adolescents (230 boys and 186 girls) aged 13 to 181/2 years.

Main Exposures  Muscle strength score was computed as the mean of the handgrip and standing broad jump standardized values. The adolescents were categorized as overweight (including obese) or nonoverweight according to body mass index. Body fat and fat-free mass were derived from skinfold thickness.

Outcome Measures  C-reactive protein, complement factors C3 and C4, ceruloplasmin, and prealbumin levels.

Results  The results of the regression analysis showed that C-reactive protein, C3, and ceruloplasmin were negatively associated with muscle strength after controlling for sex, age, pubertal status, weight, height, socioeconomic status, and cardiorespiratory fitness. Moreover, C-reactive protein and prealbumin levels were associated with muscle strength in overweight adolescents after controlling for potential confounders, including body fat and fat-free mass.

Conclusions  Low-grade inflammation is negatively associated with muscle strength in adolescents. The patterns of these associations seem more relevant in overweight adolescents, suggesting that having high levels of muscle strength may counteract the negative consequences ascribed to body fat.

Design  Longitudinal population-based survey.

Setting  Twenty-eight randomly selected schools in east London, England, in 2001 and 2003.

Participants  A total of 1880 adolescents (49% male; 81% nonwhite British) aged 11 to 12 years and 13 to 14 years in 2000.

Intervention  Confidential questionnaires completed in class.

Main Outcome Measures  Persistent fatigue (extreme tiredness twice weekly or more often in the previous month at both surveys), sedentary behavior, physical activity, depressive symptoms, body mass index, and smoking.

Results  Severe fatigue was reported in 11% of participants aged 11 to 14 years and 17% of participants aged 13 to 16 years. Eighty-four participants (4%) reported persistent fatigue. Across both surveys, only 3 pupils reported chronic fatigue syndrome. In multivariate logistic regression, risk of persistent fatigue was independently associated with being sedentary for more than 4 hours per day (odds ratio = 1.6; 95% confidence interval, 1.1-2.3; P = .01), being physically active (odds ratio = 1.5; 95% confidence interval, 1.1-2.3; P = .004), and depressive symptoms (odds ratio = 2.0; 95% confidence interval, 1.5-2.7; P < .001) in the first survey, after adjustment for age, sex, and socioeconomic status. Obesity and smoking were not associated with fatigue.

Conclusions  Persistent fatigue is common. Being highly sedentary or highly active independently increased the risk of persistent fatigue, suggesting that divergence in either direction from healthy levels of activity increases the risk for persistent fatigue. Mental health is important in the etiology of persistent fatigue. To help define effective preventive strategies, further work is needed on the mechanisms by which these factors contribute to fatigue.

Design  A longitudinal, 4-year, 3-wave study of a representative sample of Massachusetts youth.

Setting  A total of 301 Massachusetts communities.

Participants  Study participants were 3834 Massachusetts youths aged 12 to 17 years at baseline, from January 2, 2001, to June 18, 2002, of whom 2791 (72.8%) were reinterviewed after 2 years (from January 30, 2003, to July 31, 2004) and 2217 (57.8%) were reinterviewed after 4 years (from February 16, 2005, to March 26, 2006). Wave 3 respondents were recruited from both those who responded at wave 2 and those who did not.

Main Exposure  The primary predictor of interest is the strength of the local restaurant smoking regulation in the respondents' town of residence at the baseline of each transition period.

Main Outcome Measures  (1) Overall progression to established smoking (having smoked ≥100 cigarettes in one's lifetime), (2) transition from nonsmoking (never having puffed a cigarette) to experimentation, and (3) transition from experimentation to established smoking.

Results  Youths living in towns with a strong restaurant smoking regulation at baseline had significantly lower odds of progressing to established smoking (odds ratio, 0.60; 95% confidence interval, 0.42-0.85) compared with those living in towns with weak regulations. The observed association between strong restaurant smoking regulations and impeded progression to established smoking was entirely due to an effect on the transition from experimentation to established smoking (odds ratio, 0.53; 95% confidence interval, 0.33-0.86).

Conclusion  Local smoke-free restaurant laws may significantly lower youth smoking initiation by impeding the progression from cigarette experimentation to established smoking.

Design  Parents of twins completed the Children's Sleep Habits Questionnaire.

Setting  Families were primarily tested at the Institute of Psychiatry, London, England.

Participants  A total of 300 pairs of 8-year-old twins and their parents participated in the study.

Main Outcome Measures  Sleep difficulties in children.

Results  Individual differences in parasomnias and dyssomnias were largely explained by genes (accounting for 50% and 71% of the variances, respectively). The rest of the variances were mainly due to nonshared environmental influences. A moderate association was found between parasomnias and dyssomnias (r = 0.42), which was mainly accounted for by genetic influences (87%). The genetic correlation between parasomnias and dyssomnias was moderate (r = 0.61). In contrast, the nonshared environmental correlation was small (r = 0.10).

Conclusions  The decomposition of the association between parasomnias and dyssomnias suggests that there may be different manifestations of shared underlying genetic risks for sleep problems partly dependent on nonshared environmental influence.

Design  Longitudinal survey.

Setting  Multisite group practice in Massachusetts.

Participants  Nine hundred fifteen children in Project Viva, a prospective cohort.

Main Exposure  At children's ages 6 months, 1 year, and 2 years, mothers reported the number of hours their children slept in a 24-hour period, from which we calculated a weighted average of daily sleep.

Main Outcome Measures  We used multivariate regression analyses to predict the independent effects of sleep duration (< 12 h/d vs ≥ 12 h/d) on body mass index (BMI) (calculated as the weight in kilograms divided by the height in meters squared) z score, the sum of subscapular and triceps skinfold thicknesses, and overweight (BMI for age and sex ≥ 95th percentile) at age 3 years.

Results  The children's mean (SD) duration of daily sleep was 12.3 (1.1) hours. At age 3 years, 83 children (9%) were overweight; the mean (SD) BMI z score and sum of subscapular and triceps skinfold thicknesses were 0.44 (1.03) and 16.66 (4.06) mm, respectively. After adjusting for maternal education, income, prepregnancy BMI, marital status, smoking history, and breastfeeding duration and child's race/ethnicity, birth weight, 6-month weight-for-length z score, daily television viewing, and daily participation in active play, we found that infant sleep of less than 12 h/d was associated with a higher BMI z score (β, 0.16; 95% confidence interval, 0.02-0.29), higher sum of subscapular and triceps skinfold thicknesses (β, 0.79 mm; 95% confidence interval, 0.18-1.40), and increased odds of overweight (odds ratio, 2.04; 95% confidence interval, 1.07-3.91).

Conclusion  Daily sleep duration of less than 12 hours during infancy appears to be a risk factor for overweight and adiposity in preschool-aged children.

Design  Medical record review.

Setting  Academic pediatric medical center.

Participants  Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB.

Outcome Measures  History of behavioral, emotional, and academic problems and Child Behavior Checklist (CBCL) scores.

Results  More than half (56%) of the sample was overweight or at risk for overweight, more than one-third (36%) was classified as being short sleepers, and almost half (49%) had at least 1 additional sleep diagnosis. Forty-seven perent had a history of behavioral problems and 23% had a reported diagnosis of attention-deficit/hyperactivity disorder. There were no significant differences in CBCL scores based on any measure of SDB disease severity. Increased weight was associated with increased internalizing CBCL scores in a dose-dependent fashion (P = .003), while short sleepers were more likely to have elevated externalizing scores (P < .001). Overall, the strongest predictor of adverse behavioral outcomes was the presence of at least 1 additional sleep diagnosis (P < .001).

Conclusions  The relationship between SDB and parent-reported behavioral outcomes in children is complex. In addition to SDB-related impairments, clinicians should consider the relative contributions of being overweight, insufficient sleep, and comorbid sleep disorders when assessing behavior in these children.

Design  Case-control study.

Setting  A child and adolescent psychiatric department of a teaching hospital.

Participants  Two hundred six children aged 5 to 11 years, including 45 with a diagnosis of ADHD, 64 with a diagnosis of other psychiatric diagnoses (psychiatric control group), and 97 healthy control subjects (reference group).

Intervention  Sleep was monitored by parent-completed sleep diaries and 5 nights of actigraphy. We used a semistructured interview to diagnose psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria.

Main Outcome Measures  Actigraphically measured sleep variables and parent-estimated sleep by diary.

Results  We found that children with ADHD have significantly longer sleep onset latency and a more irregular sleep pattern than the psychiatric control or healthy reference subjects. Average sleep onset latencies were 26.3 minutes in the ADHD group, 18.6 minutes in the psychiatric control group, and 13.5 minutes in the healthy reference group. There was no apparent relationship between sleep problems and comorbid oppositional defiant disorder. We found discrepancies between the objectively measured sleep variables and those reported by parents, who overestimated sleep onset latency.

Conclusions  The results of this study allow us to conclude that some children with ADHD have impaired sleep that cannot be referred to comorbid oppositional defiant disorder. However, it is important to make an in-depth review of the sleep complaints, as the problem may be a product of the parents' perception rather than the child's actual experience.

Trial Registration  clinicaltrials.gov Identifier: NCT00224731

Design  Prospective longitudinal study.

Setting  The Dutch province of Zuid-Holland.

Participants  At time 1 of data collection, a representative sample of 2076 children aged 4 to 16 years participated in the study.

Outcome Measures  Parents rated their children's (4-19 years old) sleep at 5 assessments by completing the Child Behavior Checklist. Participants reported on their own emotional and behavioral symptoms at a later assessment (when aged 18-32 years) by completing the Young Adult Self-Report.

Results  After adjusting for sex, age, socioeconomic status, and parent-rated scores through development for the difficulty being predicted, having any parental reports of sleeping less than others was a risk indicator of high scores on the Anxious/Depressed scale (odds ratio, 1.43; 95% confidence interval, 1.07-1.90; P = .01) and the Aggressive Behavior scale (odds ratio, 1.51; 95% confidence interval, 1.13-2.02; P = .005). There was some (albeit less robust) support for links between other reported sleep difficulties and later problems. Parental reports of sleeping more than others and nightmares were not associated with later difficulties.

Conclusions  Physicians should inquire about sleep problems during child development and should be aware that some, but perhaps not others, may constitute risk indicators of later difficulties.

Design  Cross-sectional survey.

Setting  Pediatric hospital outpatient clinic, private pediatricians' offices, and ADHD support groups in Victoria, Australia.

Participants  Schoolchildren with ADHD.

Main Exposure  Attention-deficit/hyperactivity disorder.

Outcome Measures  Primary measure was caregivers' reports of their children's sleep problems (none, mild, or moderate or severe). Secondary outcomes were (1) child QOL (Pediatric Quality of Life Inventory), daily functioning (Daily Parent Rating of Evening and Morning Behavior scale), and school attendance, (2) caregiver mental health (Depression Anxiety Stress Scale) and work attendance, and (3) family functioning (Child Health Questionnaire subscales). Caregivers also reported on how their pediatrician treated their children's sleep problems.

Results  Two hundred thirty-nine of 330 (74%) eligible families completed the survey. Child sleep problems were common (mild, 28.5%; moderate or severe, 44.8%). Moderate or severe sleep problems were associated with poorer child psychosocial QOL, child daily functioning, caregiver mental health, and family functioning. After adjusting for confounders, all associations held except for family impacts. Compared with children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late to work. Forty-five percent of caregivers reported that their pediatricians had asked about their children's sleep and, of these, 60% reported receiving treatment advice.

Conclusions  Sleep problems in children with ADHD are common and associated with poorer child, caregiver, and family outcomes. Future research needs to determine whether management of sleep problems can reduce adverse outcomes.