The increasing number of obese children and adolescents across the Nation has led policymakers to rank it as a critical public health threat. Since the 1970s, the prevalence of obesity has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children aged 6-11 years. At present, approximately 9 million children over 6 years of age are obese.
Youths are more likely to be counseled about diet and exercise following a diagnosis of obesity.
The researchers used data from two surveys during the period 1997-2000 involving 39,340 outpatient visits by youths aged 2 to 18. Clinicians diagnosed obesity at less than 1 percent of all visits. Factors associated with diet counseling at well-child visits were diagnosis of obesity, being seen by pediatricians, ages 2 to 5 years compared with 12 to 18 years, and self-pay compared with private insurance. Factors associated with exercise counseling were similar, but this counseling occurred only half as often in visits by black youths as in visits by white youths.
Cook, Weitzman, Auinger, and Barlow, Pediatrics 116(1):112-116, 2005 (AHRQ grant HS13901).
School-based weight loss/exercise programs found effective for some children in Louisiana.
One-fourth of the 279 Louisiana middle school children enrolled in a school-based weight loss program were overweight or obese. Most of the children enrolled in the program were black and from low-income families. Twenty-eight of the children attended a food and fitness class; the rest of the children participated in a free alternative physical education (PE) class that involved warm-up and stretching exercises, aerobic activities, and a cool-down period. Not all students completed the PE class; those who did ended with lower body mass indexes and a total weight loss of 33.25 pounds. Children in the other group ended with a total weight loss of 6.5 pounds.
Edwards, Nurs Clin North Am 40(4):661-669, 2005 (AHRQ grant HS11834).
Late bottle-weaning is associated with an increased risk of overweight.
The American Academy of Pediatrics recommends introducing the cup to babies at 6 months and complete bottle weaning at 15 months, yet 20 percent of 2 year olds and 9 percent of 3 year olds are still using a bottle, according to this study. This study found that children less than the 85th percentile BMI (normal weight) were weaned from a bottle on average at 18 months, compared with 19 months for those in the 85th to 95th percentile BMI (overweight) and over 22 months for children greater than the 95th percentile BMI (obese). Each additional month of bottle use corresponded to an approximate 3 percent increase in the odds of being in a higher BMI category.
Bonuck, Kahn, and Schechter, Clin Pediatr 43:535-540, 2004 (AHRQ grant HS10900).
Controlling diet and physical activity can help obese and overweight children control their weight.
Excess weight in children is due primarily to poor eating habits and inactivity. Weight loss through diet, exercise, and limits on TV viewing and computer use should focus on maintaining a child's baseline weight. For children ages 2 to 7, weight loss of no more than 1 pound per month is recommended. A more aggressive weight loss program should be considered for children older than 7 who have a BMI for age greater than 95 percent and those who are at risk for becoming overweight (BMI for age of 85 to 95 percent) and have secondary complications (e.g., high blood pressure or high cholesterol).
Greaser and Whyte, Consultant 1349-1353, 2004 (Intramural).*
AHRQ and its partners have created new tools to help combat childhood obesity.
AHRQ and FitTV have partnered to produce a fun and interactive DVD for children ages 5 to 9 and their parents. The DVD, Max's Magical Delivery: Fit for Kids, is a 30-minute tool that provides fun ways to incorporate physical activity and healthy foods into the daily lives of children. A second DVD, Childhood Obesity: Combating the Epidemic, provides pediatricians and other providers with information about new methods for assessing and treating childhood overweight and obesity.
Copies of the DVDs (AHRQ Publication No. 04-0088-DVD, children and parents; 04-0089-DVD, clinicians) are available from AHRQ.*
Black and Hispanic children are much more likely than other children to be overweight.
Black and Hispanic children ages 6 to 11 are much more likely than non-Hispanic white children and Asian children to be overweight, according to this analysis of interview data from the 1996 Medical Expenditure Panel Survey Household Component. The odds change dramatically when children become teenagers. As teens, Asian/Pacific Islander children are more than four times as likely as non-Hispanic white teens to be overweight. Also, regardless of their race or ethnicity, adolescents not covered by private health insurance and those enrolled in Medicaid are the most likely to be overweight.
Haas, Lee, Kaplan, et al., Am J Public Health 93(12):2105-2110, 2003 (AHRQ grants HS10771 and HS10856).
In order to reverse trends of under use and disparities in oral care for children, researchers are studying incentives to improve access to and delivery of care.
Rural children with special health care needs often do not receive needed dental care.
Children with special health care needs (CSHCN) who reside in rural areas are less likely than their urban counterparts to receive needed dental care. An analysis of data on more than 37,000 CSHCN aged 2 and older revealed that children living in rural areas were 17 percent more likely than those living in urban areas to have an unmet need for dental care. The researchers cite two main reasons for this disparity: one, rural parents do not full appreciate the need for dental care, and two, dental care may be difficult to access for rural families.
Skinner, Slifkin, and Mayer, J Rural Health 22(1):36-42, 2006 (AHRQ grant HS13309).
WIC participation improves poor children's access to dental care.
Over one-third of infants born in the United States are enrolled in WIC. This study found that participation in WIC was linked with increased use of preventive and restorative dental services and decreased use of emergency services for oral problems among 50,000 preschool-aged children covered by Medicaid.
Lee, Rozier, Norton, et al., Am J Public Health 94(5):772-777, 2004 (AHRQ grants HS11607 and T32 HS00032).
Project focuses on use of dental sealants.
The goal of this project was to evaluate the effects of initiating a dental sealant benefit in the North Carolina Medicaid program on service provision, treatment outcomes, and cost-effectiveness.
Richard G. Rozier, PI (AHRQ grant HS06993), Strategies for Management of Dental Caries in Children (Final Report, NTIS Accession No. PB2004-103390).**
Task Force recommends fluoride supplements for some children.
Physicians who practice in areas where the water supply is deficient in fluoride should prescribe oral fluoride supplements to preschool children over the age of 6 months, according to a recommendation from the U.S. Preventive Services Task Force.
USPSTF, Am J Prev Med 26(4):326-329, 2004.
Also: Bader, Rozier, Lohr, and Frame, Am J Prev Med 26(4):315-325,
2004 (290-97-0018).
Study associates secondhand smoke with tooth decay in kids.
Data from household interviews and health examinations of approximately 4,000 children ages 4 to 11 show that children had an increased risk of tooth decay if they had high levels of cotinine (a by-product of nicotine). About 32 percent of the children with cotinine levels consistent with secondhand smoke exposure had decayed surfaces, compared with 18 percent of children with lower levels of cotinine.
Aligne, Moss, Auinger, et al., JAMA 289(10):1258-1264, 2003 (cofunded by AHRQ and HRSA contract 240-97-0043).
Otitis media (middle ear infection) is a common childhood illness that affects more than half of children under age 5 each year. Current debate revolves around antibiotic use and the long-term effects of ear infection on functioning, behavioral problems, and parental stress.
More than two-thirds of children visiting a physician for a sore throat receive antibiotics.
An analysis of data from the Medical Expenditure Panel Survey (MEPS) shows that 14 percent of U.S. children visit a health care provider at least once a year for a serious sore throat, and almost 70 percent of these children are prescribed antibiotics. The data also show that about one of every five children who is prescribed an antibiotic for a sore throat does not receive a throat swab to confirm a bacterial infection.
Treatment of Sore Throats: Antibiotic Prescriptions and Throat Cultures for Children Under 18 Years of Age, MEPS Statistical Brief 137, available online at www.meps.ahrq.gov/mepsweb (Intramural).
Researchers examine trends in antibiotic use among children.
From 1996 to 2001, children's use of antibiotics sharply declined by 8.5 percent overall and 5.1 percent for respiratory tract infections. This decline followed the launch of several national campaigns to promote the appropriate use of antibiotics. An analysis of data from AHRQ's Medical Expenditure Panel Survey found reductions in use among all subgroups of children. However, the decline in overall antibiotic use for white children was more than double the decline for black or Hispanic children.
Miller and Hudson, Med Care 44(5 Suppl):36-44, 2006 (AHRQ Publication No. OM-06-0074, for single copies of the journal)* (Intramural).
Pocket card facilitates shared parent/physician decisionmaking about treatment for acute otitis media.
A simple pocket card has been developed to help physicians and parents work together to decide on the appropriate treatment for a child with acute otitis media (AOM). The pocket card combines a parent's assessment of the child's symptoms (using a scale of facial expressions) with the clinician's assessment of tympanic membrane inflammation and middle ear appearance (using an otoscopy scale) to determine AOM severity. After considering this rating of AOM severity, the child's age, and the presence or absence of other risk factors, the clinician and parent can decide on the appropriate treatment plan.
Friedman, McCormick, Pittman, et al., Pediatr Infect Dis J 25(2):101-107, 2006 (AHRQ grant HS10613).
Four clinical factors can help diagnose pneumonia in children seen in the ER.
This study involved 510 children aged 2 to 59 months who arrived in the emergency department of one Cincinnati hospital during the period 2000-2002. The children presented with a cough and one or more of the following symptoms: labored, rapid, or noisy breathing; chest or abdominal pain; and/or fever; 8.6 percent of children had x-ray evidence of pneumonia. The children who had pneumonia differed from those who did not on four characteristics: older age (20.9 vs. 14.8 months), faster respiratory rate (49.8 vs. 42.7 breaths per minute), lower oxygen saturation (95.5 vs. 97.8), and nasal flaring (22.7 vs. 7.7 percent).
Mahabee-Gittens, Grupp-Phelan, Brody, et al., Clin Pediatr 44:427-435, 2005 (AHRQ grant HS11038).
Parents are more satisfied when doctors prescribe antibiotics for their child's cough or cold symptoms.
Children receive an average of two to three antibiotic prescriptions a year, many of which are unnecessary. Clinicians believe that parents will be more satisfied with their office visit when antibiotics are prescribed, and findings from this study suggest they are right. Researchers interviewed 378 parents of children 2 to 10 years of age who were seen at a pediatric clinic for cough and cold symptoms. Nearly half (47 percent) received antibiotics at the initial visit, and their parents gave higher satisfaction scores (9.25 on a 10 point scale) compared with parents whose children did not receive antibiotics (8.95). When children received antibiotics at a subsequent visit, the parents' scores averaged 7.25, compared with 6.25 for parents of children who did not receive antibiotics.
Christakis, Wright, Taylor, and Zimmerman, Pediatr Infect Dis J 24(9):1-4, 2005 (AHRQ grant HS13195).
Doctors still prescribe antibiotics for over half of children with sore throats.
Prescribing of antibiotics for sore throats—most of which are viral—has declined over the last few years, from 66 percent of visits in 1995 to 54 percent of visits in 2003. Nevertheless, doctors still are ordering antibiotics for more than half of children who have a sore throat. With more than 7 million pediatric visits each year for sore throat, inappropriate use of antibiotics continues to be a serious problem.
Linder, Bates, Lee, and Finkelstein, JAMA 294(18):2315-2322, 2005 (AHRQ grants HS14563 and HS13908).
Researchers compare immediate antibiotic treatment with watchful waiting for nonsevere acute otitis media (AOM) in children.
This study found that immediate antibiotic treatment for nonsevere AOM in children 6 months to 12 years provided superior early results compared with watchful waiting, but results were nearly identical between the two groups at 30 days. The study involved 112 children who were randomized to receive immediate antibiotics (amoxicillin and symptom medication) and 111 children who were randomized to watchful waiting (symptom medication only). Two-thirds of the children in the watchful waiting group completed the study without needing antibiotics.
McCormick, Chonmaitree, Pittman, et al., Pediatrics 115(6):1455-1465,
2005 (AHRQ grant HS10613).
Also: Trends in Children's Antibiotic Use: 1996-2001, MEPS Research Findings
No. 23 (AHRQ Publication No. 05-0020)*
(Intramural).
Few physicians initially try watchful waiting for children with nonsevere acute otitis media.
The investigators surveyed 160 physicians and 2,054 parents of children younger than age 6 in 16 Massachusetts communities about their attitudes toward watchful waiting in children with nonsevere AOM. A majority of physicians reported at least occasional use of watchful waiting, but few used it frequently. For example, 38 percent of physicians treating children aged 2 or older said they never or almost never used watchful waiting, 39 percent reported occasional use, and 6 percent said they used it most of the time. About one-third of parents reported that they would be satisfied if their doctor recommended watchful waiting, 26 percent said they would be neutral, and 40 percent said they would be somewhat or extremely dissatisfied.
Finkelstein, Stille, Rifas-Shiman, and Goldmann, Pediatrics 115(6):1466-1473, 2005 (AHRQ grant HS10247).
Use of broad-spectrum antibiotics to treat childhood infections has increased.
Despite recent downward trends in antibiotic use to treat infections in children, use of certain broad-spectrum antibiotics (second-generation macrolides) to treat children has increased. According to the researchers, use of these drugs has increased because they are effective against a broad spectrum of bacteria, require less frequent dosing, and have fewer gastrointestinal side effects than other antibiotics. Nevertheless, experts generally do not recommend second-generation macrolides for initial treatment of infections in younger children, in part because of growing bacterial resistance to antibiotics. Instead, they support the use of narrower spectrum agents whenever appropriate.
Stille, Andrade, Huang, et al., Pediatrics 114(5):1206-1211, 2004 (AHRQ grant HS10391).
Use of alcohol-based hand gel may reduce transmission of respiratory illnesses in homes with young children who attend day care.
The researchers analyzed transmission rates for respiratory and gastrointestinal (GI) illnesses among 208 ethnically diverse families with children enrolled in child care who were treated at five suburban practices in the Boston area. A survey of the families revealed that a total of 1,545 respiratory and 360 GI illnesses occurred in the families from November 2000 to May 2001. Of these, 54 percent of the illnesses were brought into the home by children younger than 5. Twenty-two percent of respondents reported use of alcohol-based hand gels, and 33 percent reported always washing their hands after blowing or wiping a nose. After adjusting for education, insurance status, and other factors, the researchers concluded that hand gels had a protective effect against respiratory illness transmission in the home.
Lee, Salomon, Friedman, et al., Pediatrics 115(4):852-860, 2005 (AHRQ grant T32 HS00063).
Otitis media may not substantially increase the risk of delayed speech development in most children.
Half of children who have an episode of otitis media with effusion (OME) suffer mild hearing loss, while about 5 to 10 percent have moderate hearing loss. However, for normally developing children, OME may not be a substantial risk for delayed speech and language development or poorer academic achievement. Antibiotic therapy, tympanostomy tubes, and adenoidectomy increase short-term resolution of OME or reduce its occurrence, yet in the long term, hearing levels are equal in treated and untreated ears.
Roberts, Hunter, Gravel, et al., J Dev Behav Pediatr 25(2):110-122, 2004 (AHRQ grant HS12072).
Patterns of care and outcomes of pneumonia in children vary by ethnicity and race.
This study found that compared with white children, minority children are hospitalized for pneumonia at younger ages, are more likely to be admitted through the emergency department, and are less likely to receive bronchoscopy or mechanical ventilation. These findings are based on an analysis of data from the 1998, 1999, and 2000 Nationwide Inpatient Sample, which contains data on 20 percent of total U.S. hospital discharges.
Washington, Shen, Bell, et al., J Health Care Poor Underserved 15:462-473, 2004 (AHRQ grant HS13056).
Young children in disadvantaged communities may be at increased risk for Streptococcus pneumoniae.
Certain community characteristics—poverty, low educational attainment, low owner occupancy, high density of children, limited household plumbing, and others—increase the odds of carriage of disease-causing strains of S. pneumoniae two- to three-fold. The presence of these characteristics could be used to identify communities that should be targeted for interventions to decrease carriage, according to this study.
Huang, Finkelstein, Rifas-Shiman, et al., Am J Epidemiol 159(7):645-654, 2004 (AHRQ grant HS10247).
Misconceptions are common among child care center staff about common childhood infections.
The researchers surveyed staff at randomly selected child care centers in Massachusetts to assess knowledge regarding common infections. Overall, more than 80 percent of staff members incorrectly believed that antibiotics were indicated for bronchitis and for green nasal discharge in children. More than one-quarter of staff surveyed believed that antibiotics speed recovery from colds and flu and are helpful in treating viral infections.
Friedman, Lee, Kleinman, and Finkelstein, Ambulatory
Pediatr 4(5):455-460, 2004 (AHRQ grants T32 HS00063, HS10247).
Also: Kuzujanakis, Kleinman, Rifas-Shiman, and Finkelstein, Ambulatory Pediatr
3(4):203-210, 2003 (AHRQ grant HS10247).
Pneumatic otoscopy is cost effective for accurately diagnosing middle ear effusion in children.
Using a pneumatic otoscope—an instrument fitted with a light and magnifying lens—a clinician can look directly in a child's middle ear and view the transparency, position, and other qualities of the ear drum. According to this review of the evidence, pneumatic otoscopy had the best performance compared with seven other commonly used diagnostic methods. Also, after training, most clinicians should find it easier to use than other diagnostic methods.
Takata, Chan, Morphew, et al., Pediatrics 112(6):1379-1387, 2003 (contract 290-97-0001).
Premature birth increases infants' risk of hospitalization and complications from respiratory syncytial virus.
Premature infants are at much greater risk than term infants for severe respiratory syncytial virus (RSV) outcomes, including bronchiolitis and pneumonia. Complications are common in infants hospitalized for these conditions, particularly infants born prematurely, and are associated with longer stays and higher costs.
Horn and Smout, J Pediatr 143:S133-S141 and Willson, Landrigan, Horn, and
Smout, 143:S142-S149, 2003 (contract 290-95-0042).
Also: Sinha, Madden, Ross-Degnan, et al., Pediatrics 112(4), 2003; online
at www.pediatrics.org (HS10060).
Fewer antibiotics are being prescribed for U.S. children.
After decades of being on the rise, antibiotic use by U.S. children aged 3 months to 3 years fell by almost 25 percent from 1996 to 2000, according to this study. More than half of the decrease came from a drop in the number of antibiotics prescribed for childhood ear infections. There also were fewer prescriptions for children 3 months to 18 years for cold/upper respiratory infections, pharyngitis, sinusitis, and bronchitis.
Finkelstein, Stille, Nordin, et al., Pediatrics 112(3):620-627, 2003 (AHRQ grant HS10391).
Chronic middle-ear disease up to age 3 may not impair later development.
In this study of otherwise healthy children who had persistent middle-ear effusion (MEE, fluid buildup) during the first 3 years of life, prompt insertion of tympanostomy tubes did not affect the children's language or other developmental outcomes at age 4. The study involved 429 children who had persistent MEE and underwent tube insertion either promptly or after an extended period.
Paradise, Dollaghan, Campbell, et al., Pediatrics 112(2):265-277, 2003.
Also: Paradise, Feldman, Campbell, et al., Pediatr Infect Dis J 22:309-314,
2003 (AHRQ/NICHD grant HD26026).
New vaccine reduces strains of bacteria most likely to cause severe infections.
This study of 16 Massachusetts communities found that 8 percent of children under age 7 carry antibiotic-resistant Streptococcus pneumoniae, a major cause of meningitis, bloodstream infections. When rare but dangerous infections develop, antibiotic-resistant strains make the illness harder to treat. This study examined the effectiveness of a new vaccine to protect children from the most dangerous strains of the bacteria. Results showed that immunized children were less likely to carry one of the seven more invasive strains, and thus they were at lower risk of contracting a serious illness.
Finkelstein, Huang, Daniel, et al., Pediatrics 112(4):862-869, 2003 (AHRQ grant HS10391).
More than half of parents believe that antibiotics are needed to treat a common cold.
In this study, 66 percent of parents believed that colds are caused by bacteria; 53 percent of the parents believed that antibiotics are needed to treat colds. Also, 23 percent said they would take their child to the ED if they had a cold, and 60 percent said that a cold would warrant a doctor's visit.
Lee, Friedman, Ross-Degnan, et al., Pediatrics 111(2):231-236, 2003 (AHRQ grant T32 HS00063).
Study associates maternal education with child's language skills.
This study examined the degree of association between parent-reported language scores and the cumulative duration of MEE during the first 3 years of life in 621 children. Scores increased as the level of maternal education increased, and within each maternal-education subgroup, scores decreased as the duration of MEE increased.
Feldman, Dollaghan, Campbell, et al., J Speech, Lang Hear Res 46:273-287, 2003 (AHRQ and NICHHD grant HD26026).
Accumulation of risk factors delays speech.
Researchers compared 100 3-year-olds with speech delay of unknown origin and 539 same-age peers, and examined abnormal hearing in a subset of 279 children. Low maternal education, male sex, and a family history of developmental communication disorder increased the likelihood of speech delay. A child with all three factors was nearly eight times as likely to have speech delay as a child without any of the factors.
Campbell, Dollaghan, Rockette, et al., Child Dev 74(2):346-357, 2003 (AHRQ/NICHHD grant HD26026).
Middle ear status, age, and test influence audiometric results.
Researchers tested 1,055 children with MEE; unilateral MEE; or bilateral MEE for age-specific hearing threshold levels. Thresholds were highest in the youngest children and lowest in the oldest children. Thresholds were lowest in children with normal middle ear status, intermediate in children with unilateral MEE, and highest in children with bilateral MEE.
Sabo, Paradise, Kurs-Lasky, et al., Ear Hear 24(1):38-47, 2003 (AHRQ and NICHHD grant HD26026).
Parents may influence pediatricians' treatment decisions.
An analysis of audiotapes and videotapes of 295 acute care visits reveals that parents often pressure pediatricians to prescribe antibiotics for their children. The doctors prescribed antibiotics in 15 of the 31 cases involving overt pressure. When parents only discussed their children's symptoms, pediatricians perceived parents wanted a medical evaluation and complied. When parents offered a candidate diagnosis (in 16 percent of cases), 82 percent of the cases were treated with antibiotics.
Stivers, Soc Sci Med 54(7):1111-1130, 2002.
Also: Stivers, Health Commun 14(3):299-338, 2002.
Also: Stivers, Mangione-Smith, Elliott, et al., J Fam Pract
52(2):140-148, 2003 (AHRQ grant HS10577).
Misconceptions lead to parental demand for antibiotics.
Thirty-six day care centers and 398 parents were surveyed about their beliefs and the centers' policies for excluding children, requiring physician clearance, or enforcing their policies regarding symptoms of upper respiratory tract infection. Responses revealed that only 4 percent of parents felt pressured by staff to see a doctor or obtain an antibiotic (2 percent). However, 20 percent believed most colds and flu illnesses are caused by bacteria and get better faster with antibiotics.
Friedman, Lee, Kleinman, et al., Arch Pediatr Adolesc Med 157:369-374, 2003 (AHRQ grant HS00063).
The majority of injuries and deaths in children and adolescents are preventable. Although the importance of preventive services has been demonstrated, there still are barriers, flaws, and disparities in the content and delivery of clinical preventive services.
Use of stimulants to treat ADHD has leveled off in recent years.
Stimulants, such as methylphenidate (Ritalin) and amphetamines, are commonly prescribed to treat children with attention deficit hyperactivity disorder (ADHD). Use of these medications increased four-fold from 1987 (0.6 percent) to 1996 (2.4 percent) among U.S. children aged 18 and younger, but this trend seems to have abated. According to this study, the prevalence in use of stimulants among children aged 18 or younger was 2.7 percent in 1997 and 2.9 percent in 2002, with no statistically significant change during these 6 years. Use was highest among children aged 6-12 (4.8 percent in 2002), compared with 3.2 percent among those aged 13-19, and 0.3 percent for children younger than age 6.
Zuvekas, Vitiello, and Norquist, Am J Psychiatr 163:579-585, 2006 (AHRQ Publication No. 06-R063)* (Intramural).
Two studies find low levels of preventive care and suboptimal provision of anticipatory guidance.
Researchers studied 44 private pediatric and family medicine practices in North Carolina and found low levels of preventive care, with substantial variation among practices. Only 39 percent of children received three of four recommended preventive services: immunizations, testing for anemia, tuberculosis testing, and lead screening by age 2. The range among clinics was 2 to 88 percent. On average, physicians spent less than 2.5 minutes of each well-child visit on anticipatory guidance (i.e., counseling parents about child development, injury prevention, nutrition, and other topics).
Rosenthal, Lannon, Stuart, et al., Arch Pediatr Adolesc Med 159:456-463, 2005 (AHRQ grant HS08509).
Pneumococcal carriage seems to be more prevalent in communities that have more children in day care.
Children often carry the pneumococcal bacteria that can cause pneumonia, ear infections, and other illnesses, but carriage rates differ from one community to another. Factors such as age and number of siblings account for some of the differences, but other factors—such as the proportion of children in a community who attend child care centers—also play a role. In this study, the researchers examined data on asymptomatic children in 16 Massachusetts communities and found that the odds of carriage were two to three times as high for youngsters attending child care centers compared with those were not in child care.
Huang, Finkelstein, and Lipsitch, Clin Infect Dis 40:1215-1222, 2005 (AHRQ grant HS10247).
Routine vaccination of adolescents for whooping cough would be cost effective.
Although nearly all young children are vaccinated against pertussis, their immunity wanes by the mid-teens. This has resulted in sharply increased rates of whooping cough among adolescents and young adults in recent years. This study found that a one-time adolescent pertussis vaccination would cost $15 and be both beneficial to health and cost effective.
Lee, LeBaron, Murphy, et al., Pediatrics 115(6):1675-1684, 2005
(AHRQ grants T32 HS00063 and HS13908).
Also: Lee, Lett, Schauer, et al., Clin Infect Dis 39:1572-1580, 2004 (AHRQ
grant T32 HS00063).
Altering the vaccination schedule for RotaShield could greatly lower the risk of intussusception.
RotaShield, a vaccine intended to prevent severe rotavirus diarrhea among infants and children, was withdrawn in July 1999 because of a link between the vaccine and intussusception (intestinal obstruction) in vaccinated infants. These researchers found that the incidence of intussusception associated with the first dose of RotaShield increases with age (infants 90 days and older accounted for 80 percent of cases), and that altering the vaccination schedule could markedly reduce the risk. They calculated that a two-dose neonatal vaccination schedule administered at 0-29 days and 30-59 days of age would lead to, at most, a 7 percent increase in the incidence of intussusception above the annual background incidence.
Simonsen, Viboud, Elixhauser, et al., J Infect Dis 192:S36-S43, 2005 (AHRQ Publication No. 06-R002)* (Intramural).
Evidence is limited to support recommendations for preventive care during well-child visits.
These researchers sought evidence of effectiveness for a total of 42 preventive interventions (not including immunizations) in three categories: behavioral counseling to reduce risky behavior or increase healthy behavior, screening, and prophylaxis. They found limited evidence that counseling can change some health risk behaviors (such as seat belt and car seat use), and that repeated intensive counseling is likely to be most effective. Evidence in support screening was very limited, as was evidence to support prophylactic approaches (e.g., vitamin supplements).
Moyer and Butler, Pediatrics 114(6):1511-1521, 2004 (AHRQ contract 02-R00012801D).
Only limited evidence supports many recommendations for preventive care during well-child visits.
Professional organizations, government agencies, and other groups have made many and sometimes conflicting recommendations about what should be included in well-child visits. Yet, according to this study, there is limited direct evidence to support 42 commonly recommended preventive interventions, including oral fluoride treatment, counseling to increase healthy behaviors, and scoliosis screening.
Moyer and Butler, Pediatrics 114(6):1511-1521, 2004 (AHRQ contract 02-R00012801D).
Task Force recommends vision screening for children younger than 5.
Visual impairment affects 5 to 10 percent of preschool age children, according to the U.S. Preventive Services Task Force. They recommend that children younger than 5 be screened in the primary care setting for vision problems, including lazy eye, crossed eyes, and near- and far-sightedness.
Gresenz and Studdert, Ann Emerg Med 43(2):155-162, 2004 (contract 290-97-0018).
Staff education and improved processes in physicians' offices can enhance preventive care for children.
A practice-based, team approach involving education and coaching of medical office staff in quality improvement can enhance the delivery of preventive care for children, according to this 30-month study of 44 practices that were randomly divided into intervention and control groups. The researchers compared change over time in the proportion of children aged 24-30 months who received age-appropriate care for four preventive services: immunizations and screening for tuberculosis, anemia, and lead. After 1 year, delivery of all preventive services had improved from 7 to 34 percent in intervention practices and from 9 to 10 percent in control practices.
Margolis, Lannon, Stuart, et al., Br Med J 328:388-394, 2004 (AHRQ grant HS08509).