US School-aged Children Research Articles

Prevalence and Correlates of Suspected and Diagnosed Traumatic Brain Injuries among US School-Aged Children

ObjectiveTo (1) estimate the lifetime prevalence of suspected and diagnosed TBI based on parent report overall and select sociodemographic characteristics; and (2) describe differences in prevalence of health conditions and health-related risk factors by whether a child had a lifetime history of diagnosed TBI. Study DesignWe analyzed data from the 2020 National Survey of Children’s Health, a cross-sectional address-based survey of U.S. households. A categorical variable was created based on parent responses to 3 questions inquiring about their suspicion of their child having a brain injury, if they sought medical care, and if the healthcare provider provided a diagnosis. Parents were also asked to report on their child’s additional health conditions, functional indicators, school and social factors, and healthcare access and service utilization. ResultsThe prevalence of lifetime diagnosed TBI was 4.2% (95% CI: 3.8, 4.5). Children with a parent-reported lifetime history of diagnosed TBI were more likely to have a variety of health conditions, special healthcare needs, disabilities, activity limitations, missed days of school, and unmet care coordination needs, compared to those without a history. However, they were more likely to have a usual source of sick care and to receive more health-related services. Conclusions and RelevanceFor school-aged children, a history of TBI is associated with parent reported health needs and conditions, as well as missed days from school. It is particularly important for parents to seek care when they suspect their child has experienced a TBI to receive a diagnosis and monitor the impacts of the TBI.

Age, sex and race distribution of accelerometer-derived sleep variability in US school-aged children and adults

Sleep variability (e.g. intra-individual variabilities in sleep duration or sleep timing, social jetlag, and catch-up sleep) is an important factor impacting health and mortality. However, limited information is available on the distribution of these sleep parameters across the human life span. We aimed to provide distribution of sleep variability related parameters across lifespan by sex and race in a national representative sample from the U.S. population. The study included 9981 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011–2014, who had 4–7 days of valid 24-h accelerometer recording with at least one day obtained during weekend (Friday or Saturday night). Of the study participants, 43% showed ≥ 60 min sleep duration standard deviation (SD), 51% experienced ≥ 60 min catch-up sleep, 20% showed ≥ 60 min sleep midpoint SD, and 43% experienced ≥ 60 min social jetlag. American youth and young adults averaged greater sleep variability compared to other age groups. Non-Hispanic Blacks showed greater sleep variability in all parameters compared to other racial groups. There was a main effect of sex on sleep midpoint SD and social jetlag with males averaging slightly more than females. Our study provides important observations on sleep variability parameters of residents of the United States by using objectively measured sleep patterns and will provide unique insights for personalized advice on sleep hygiene.

Her Chinese name means beautiful: culture, care and naming practices

PurposeNaming practices reflect culture, language and identity considerations. This study aims to explore Chinese American naming choices, revealing nuanced and complex linguistic, cultural and pragmatic considerations for teachers of literacy.Design/methodology/approachThe authors interviewed Chinese parents who are now living with their school-aged children in the USA on the naming choices of their students. By using content analysis, this study found patterns and themes from the interview data.FindingsThe findings of this study suggest Chinese parents named their US school-aged children by taking into consideration of both Mandarin and English linguistic features, traditional and pop culture and the transnational identity of their children.Originality/valueThe findings of this study can help teachers and teacher educators better understand the naming traditions of Chinese American families and connect these traditions to literacy instruction in the classroom. This study proposes practical suggestions suitable for both monolingual and multilingual students to explore all children’s names and help build inclusive, culturally sustaining classrooms.

Learning Modality and Quality of Life Among US School-Age Children During the Coronavirus Pandemic.

Shifts from in-person learning to virtual and hybrid learning modes in response to the coronavirus pandemic potentially impacted children's physical, emotional, social, and academic development. This study examined the association between virtual, in-person, and hybrid learning modality with parent-reported quality of life among US students (kindergarten-12th) in early 2021. Parents reported current learning modality and physical, emotional, social, and school quality of life for children (aged 5-11, n=1381) and adolescents (aged 12-17, n=640). Multivariable logistic regression models assessed the odds of impaired quality of life by learning modality. Among children, hybrid and virtual learners had greater odds of impaired quality of life (adjusted odds ratio [aOR] 1.79, 95% confidence interval [CI] 1.22, 2.64 and aOR 1.57, 95% CI 1.17, 2.12, respectively) relative to in-person learners. Among adolescents, virtual learners had greater odds impaired physical (aOR 2.06, 95% CI 1.26, 3.38) and school function (aOR 2.23, 95% CI 1.38, 3.61) relative to in-person learners. Learning modality was associated with student well-being, and appropriate alternative learning modalities may differ for younger and older students in terms of educational quality and quality of life.

Sources of Tobacco Smoke Exposure and Their Associations With Serum Cotinine Levels Among US Children and Adolescents.

We assessed tobacco smoke exposure (TSE) levels based on private and public locations of TSE according to race and ethnicity among US school-aged children ages 6-11 years and adolescents ages 12-17 years. Data were from 5296 children and adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Racial and ethnic groups were non-Hispanic white, black, other or multiracial, and Hispanic. NHANES assessed serum cotinine and the following TSE locations: homes and whether smokers did not smoke indoors (home thirdhand smoke [THS] exposure proxy) or smoked indoors (secondhand [SHS] and THS exposure proxy), cars, in other homes, restaurants, or any other indoor area. We used stratified weighted linear regression models by racial and ethnic groups and assessed the variance in cotinine levels explained by each location within each age group. Among 6-11-year-olds, exposure to home THS only and home SHS + THS predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic white children exposed to car TSE had higher log-cotinine (β = 1.64, 95% confidence interval [CI] = 0.91% to 2.37%) compared to those unexposed. Non-Hispanic other/multiracial children exposed to restaurant TSE had higher log-cotinine (β = 1.13, 95% CI = 0.23% to 2.03%) compared to those unexposed. Among 12-17-year-olds, home SHS + THS exposure predicted higher log-cotinine among all racial and ethnic groups, except for non-Hispanic black adolescents. Car TSE predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic black adolescents with TSE in another indoor area had higher log-cotinine (β = 2.84, 95% CI = 0.85% to 4.83%) compared to those unexposed. TSE location was uniquely associated with cotinine levels by race and ethnicity. Smoke-free home and car legislation are needed to reduce TSE among children and adolescents of all racial and ethnic backgrounds. Racial and ethnic disparities in TSE trends have remained stable among US children and adolescents over time. This study's results indicate that TSE locations differentially contribute to biochemically measured TSE within racial and ethnic groups. Home TSE significantly contributed to cotinine levels among school-aged children 6-11 years old, and car TSE significantly contributed to cotinine levels among adolescents 12-17 years old. Racial and ethnic differences in locations of TSE were observed among each age group. Study findings provide unique insight into TSE sources, and indicate that home and car smoke-free legislation have great potential to reduce TSE among youth of all racial and ethnic backgrounds.

P084 The Relationship Between Middle-School Children's Body Mass Index, School Lunch Participation and Consumption

<h3>Background</h3> One in five US school-aged children is obese. The National School Lunch program is crucial for children's intake, accounting for about 1/3 of total daily calories. Previous research on obesity and school-lunch consumption has not included middle school, an important time to establish lifestyle habits that persist into adulthood. <h3>Objective</h3> To explore the relationship between school-lunch participation and consumption with child body mass index (BMI) and BMI category. <h3>Study Design, Setting, Participants</h3> This is a secondary analysis of data collected from middle-school students in Birmingham, AL. <h3>Measurable Outcome/Analysis</h3> Child weight and height were measured and BMI calculated and categorized as 2 groups (underweight + healthy weight [<85th percentile], overweight + obese [≥85th percentile]). At pre- and post-lunch, researchers weighed and photographed school-lunch trays for 5 consecutive weekdays to capture amounts at pre and post. "Offer-versus-serve" was available so students could refuse some meal components. Mixed-effects regression explored BMI and logistic regression explored BMI category (dependent variables) with school lunch participation, pre-, post-amounts, and average consumption of school lunch as independent variables, age, gender, race/ethnicity, family income as fixed effects, and school site as a random effect. <h3>Results</h3> The sample included 288 students (mean age 12 years; 46% male; 36% White, 47% African American, 9% Hispanic/Latino, 8% Other/missing) from 15 schools, 6 school districts. There was no significant relationship between school-lunch participation and BMI/BMI category. However, pre-, post-amounts, and average consumption of school-lunch in grams were all significant (β=2.23, β=-2.29, and β=1.82 respectively, <i>P</i> <0.001) with BMI. The odds of being overweight/obese will increase by 48.3% with every 1 unit increase of the standardized average lunch consumption. <h3>Conclusions</h3> School-lunch consumption was positively related with BMI and BMI category among middle school children. As BMI and obesity risk increased, pre-amounts and average consumption were larger and post-amounts were smaller. Future analyses will assess the association of school-lunch food groups and energy intake with BMI. <h3>Funding</h3> Institute of Education Sciences, United States Department of Education

Epidemiology of accelerometer-based sleep parameters in US school-aged children and adults: NHANES 2011–2014

We aimed to provide objectively measured sleep parameters across lifespan by sex and race in a national representative sample of US population. The study included 11,279 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011–2014, who had at least 3 days of valid sleep parameters calculated from 7-day 24-h accelerometer recording. Sleep duration showed a U-shaped association with age and reached the minimum at age 40 and started to increase again around age 50. The clock time for sleep onset (CTSO) delayed with age and reached the maximum at about age 20. CTSO then advanced until age 50, leveled off until age 70, then advanced again after age 70. Sleep efficiency showed an overall decreasing trend across the lifespan but stabilized from age 30 to about age 60. US young adults in age 20 s are the ones who slept at the latest around midnight, while the middle aged US residents between 40 and 50 years old slept the least. Females generally present longer sleep duration than males, while more likely to have later sleep onset, particularly at older ages. Non-Hispanic Blacks showed worse sleep characteristics, i.e. sleep later, sleep shorter, and sleep less efficiently, compared to other racial groups. In conclusion, this study provides valuable insights on the characteristics of sleep habits of residents of the United States by using objectively measurements of sleep parameters and will help guide personalized advice on sleep hygiene.

Sleep disturbances in children with functional gastrointestinal disorders: demographic and clinical characteristics.

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

Racial and Ethnic Differences in Atopic Dermatitis–Related School Absences Among US Children

This cross-sectional study examines data from the Pediatric Eczema Elective Registry to assess associations of race/ethnicity with school absences attributed to atopic dermatitis in US school-aged children (6 to 17 years).

Mentoring, Bullying, and Educational Outcomes Among US School-Aged Children 6-17 Years.

Ensuring the optimum development of all children and their attainment of age-appropriate educational outcomes is of great interest to public health researchers and professionals. Bullying and mentoring have opposite effects on child development and educational attainment. Mentoring exerts protective effects on youths against risky behaviors; however, the protective effects of community-oriented natural or informal mentoring on educational outcomes and bullying are largely underexplored. We examine associations between mentoring, bullying, and educational outcomes among US school-aged children 6-17 years. We analyzed the 2011-2012 National Survey of Children's Health (N = 65,593) to estimate prevalence and odds of repeating a grade in school, lower school engagement, and bullying perpetration according to mentoring receipt and sociodemographic characteristics. Overall, 5.4% of US school-aged children without a mentor perpetrated bullying against other children; 11.4% repeated more than one grade in school; and 23.0% had low school engagement. Children without mentors had 2.1 and 1.3 times higher adjusted odds, respectively, of bullying other children and low school engagement than those with mentors. Proportion of children who bullied others or repeated grades was higher among minority children. Findings indicate that mentoring may be a pathway for providing programs that prevent bullying and improve educational outcomes among school-aged children.

Residential Mobility and Flourishing Among United States School-Age Children, 2011/2012 National Survey of Children's Health.

Objectives To investigate the association of residential mobility with flourishing among school-age children. Methods Data from the 2011/2012 National Survey of Children's Health were used to examine parent/caregiver-reported information on flourishing and residential mobility for children age 6-17 (N = 63,333). Residential mobility was the number of times the child moved categorized as: none, 1-2, and 3+. Children who were reported to show interest/curiosity, finish tasks, stay calm/in control, care about doing well in school, and do all homework were coded as flourishing. Sex-specific multivariable models were used to model the relative risk of mobility on flourishing. Interactions of mobility with age and poverty were tested. Results Among US school-age children, 22% had no moves, 39% had 1-2 moves and 39% had 3+ moves in their lifetime. Nearly half (45%) were flourishing. Both boys and girls who moved 3+ times were less likely to flourish compared to children with no moves. Among poor boys moving 3+ times was associated with less flourishing (aRR 0.83, 95% CI 0.71, 0.98) with no association for non-poor boy. Among girls the pattern was reversed (aRR 0.88, 95% CI 0.81, 0.95 for non-poor girls and no association for poor girls). Conclusions for Practice Residential mobility may lead to lower rates of flourishing. The patterns, when stratified by age or poverty, are different for boys and girls.

Timing of household food insecurity exposures and asthma in a cohort of US school-aged children

ObjectiveFood insecurity is positively associated with asthma, the most common chronic childhood disease, yet directionality is unclear. The objective was to determine the association between exposure to food insecurity in...

Unmet Need and Financial Impact Disparities for US Children with ADHD

ObjectiveThe 5.1 million US children with attention-deficit/hyperactivity disorder (ADHD) have pronounced needs in education, occupational and speech therapy, and medical and behavioral treatments. Given known associations of ADHD diagnosis with race/ethnicity and parent education, this study aimed to assess how measures of socioeconomic status correlate with both adverse family financial impact of ADHD and disparities in unmet treatment need for ADHD. MethodsSecondary analysis of children ages 8 to 17 years whose households participated in the 2014 National Survey of the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome. Using bivariate testing, we examined associations among measures of socioeconomic status with unmet ADHD treatment need and family financial impact. Logistic regression models estimated the odds of having unmet treatment need, adjusting for demographic factors and family financial impact. ResultsAmong US school-aged children with a current ADHD diagnosis, 44.3% experienced an adverse family financial impact from ADHD, and 11.6% had unmet need for ADHD treatment. Children with younger age at first ADHD diagnosis were more likely to experience adverse family financial impact. Children from non-English-speaking households were less likely to report unmet need compared to those from primarily English-speaking households. The adjusted odds of unmet need were twice as great among those who reported adverse family financial impact. ConclusionDeeper understanding of the influence of the household language is important in ADHD needs assessments. Considering overall family financial circumstances may also be pertinent, particularly as children age, because earlier diagnosis was associated with adverse financial outcomes. These findings could shape future clinic policies for targeting community resources.

Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012

BackgroundIdentifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. ObjectiveTo describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. DesignCross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey. Participants/settingA nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. Main outcome measuresPopulation proportions of sodium intake from major food categories, places, and eating occasions. Statistical analyses performedStatistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. ResultsAverage daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children’s sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. ConclusionsWith the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren’s sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

Variation in Vaccination Data Available at School Entry Across the United States.

To compile substate-level data on US school-age children's vaccination rates. For states that did not have suitable data online, in 2015 we submitted information requests to the state health department and followed up with the state's Freedom of Information Act when necessary. The accessibility, scale, and types of vaccination data varied considerably. Whereas 26 states provided data online, 14 released data only after a Freedom of Information Act request. School or school-district data were available for 24 states, 19 at the county level, 2 at the health department level, and 6 provided no substate-level data. Effective vaccination policy requires a robust understanding of vaccination behavior. Some states make it difficult to access data or provide low-resolution data of limited value for identifying vaccination behavior.

Utilization of genetic testing among children with developmental disabilities in the United States.

PurposeSeveral professional societies recommend that genetic testing be routinely included in the etiologic workup of children with developmental disabilities. The aim of this study was to determine the rate at which genetic testing is performed in this population, based on data from a nationally representative survey.MethodsData were analyzed from the Survey of Pathways to Diagnosis and Services, a telephone-based survey of parents and guardians of US school-age children with current or past developmental conditions. This study included 3,371 respondents who indicated that their child had an autism spectrum disorder (ASD), intellectual disability (ID), and/or developmental delay (DD) at the time of survey administration. History of genetic testing was assessed based on report by the parent/s. Children were divided into the following five mutually exclusive condition groups: ASD with ID; ASD with DD, without ID; ASD only, without ID or DD; ID without ASD; and DD only, without ID or ASD. Logistic regression was used to assess the demographic correlates of genetic testing, to compare the rates of genetic testing across groups, and to examine associations between genetic testing and use of other health-care services.ResultsOverall, 32% of this sample had a history of genetic testing, including 34% of all children with ASD and 43% of those with ID. After adjusting for demographics, children with ASD + ID were more than seven times as likely as those with ASD only, and more than twice as likely as those who had ID without ASD, to have undergone genetic testing. Prior specialist care (developmental pediatrician or neurologist) and access to all needed providers within the previous year were associated with higher odds of genetic testing.ConclusionThe majority of children in this nationally representative sample did not undergo recommended genetic testing. Research is needed to identify barriers to the use of genetic testing in this population.

Predictors of favorable growth patterns during the obesity epidemic among US school children.

To report the prevalence of favorable growth patterns, including healthy weight maintenance (HWM) and return to healthy weight (RHW) among US school-age children. A longitudinal analysis of childhood growth patterns from the Early Childhood Longitudinal Study-Kindergarten Cohort was completed (n = 9416). The primary outcome included describing the prevalence of HWM/RHW patterns using consecutive child growth data from kindergarten to fifth grades. Multivariate logistic regression was used to explore predictors of HWM/RHW. Incidence of RHW is calculated by grade level. Seventy percent (n = 6617) of children enter kindergarten at a healthy weight and approximately 70% maintained a healthy weight through fifth grade. Among overweight/obese kindergartners, only 17.1% outgrew their weight risk (RHW) by fifth grade. Fewer than 1 in 5 at-risk children outgrow their weight risk during school-age yet a majority of healthy weight children can maintain healthy weight during a critical growth period. Future work should explore additional socioecologic factors associated with favorable growth.

Bilingual lexical skills of school-age children with Chinese and Korean heritage languages in the United States

This cross-sectional study investigated the bilingual lexical skills of 175 US school-age children (5 to18 years old) with Cantonese, Mandarin, or Korean as their heritage language (HL), and English as their dominant language. Primary study goals were to identify potential patterns of development in bilingual lexical skills over the elementary to high school time span and to examine the relation of environmental factors to lexical skills. HL and English productive lexical skills were assessed with a Picture Naming and a Verbal Fluency task. English receptive lexical skills were assessed with Peabody Picture Vocabulary Test. A survey obtained information about participants’ language use in six environmental contexts. There were age-related significant increases in both HL and English skills. However, English proficiency already had a significant lead over HL proficiency at the youngest age. English receptive lexical skills reached monolingual expectations from age 8, whereas for HL, high school age participants on average only reached the level of early elementary school monolinguals. Although more English use at home at younger ages was associated with stronger English skills, the relation did not exist for older participants. Instead, among older participants, more English use at home was associated with weaker HL skills. Children’s attendance at HL programs and visits to home countries bore little relation to HL proficiency.

Postnatal exposure to methyl mercury and neuropsychological development in 7-year-old urban inner-city children exposed to lead in the United States

Background: The most common route for general population exposure to methyl mercury (MeHg) is fish consumption. Recommendations to pregnant women about consuming fish contaminated with MeHg are also applied to children, but there are few studies available about the effects of low-level postnatal MeHg exposure in them.Objectives: To investigate the association between postnatal methyl mercury exposure and neuropsychological development in a study of children also exposed to lead, both measured at 7 years.Methods: We measured MeHg concentrations in blood samples from the Treatment of Lead-Exposed Children (TLC) trial in which 780 children with elevated concentrations of lead in blood were followed with neuropsychological tests from ages 12–33 months through 7 years. Here we examine blood MeHg concentration and neuropsychological test scores, both measured at age 7 years. We used a maximum likelihood method to estimate geometric mean MeHg concentration and generalized linear regression models to analyze MeHg and neuropsychological test scores.Results: Geometric mean MeHg concentration was 0.56 (95% confidence interval: 0.52, 0.59) μg/L. A 1 μg/L increase in MeHg was associated with a 2.1 (95% confidence interval: 0.4, 3.8) point increase in Full-Scale IQ and 0.2 (95% confidence interval: 0.02, 0.4) point increase in Learning Slopeindex T-score on a test of verbal memory.Conclusions: Our results suggest that the relatively low MeHg exposure in US school-aged children from this population has no detectable adverse effect on neuropsychological development. The positive associations observed between MeHg and neurodevelopment may indirectly reflect consumption of beneficial polyunsaturated fatty acids from seafood.

Excess screen time in US children: association with family rules and alternative activities.

We describe the association of screen time in excess of American Academy of Pediatrics recommendations (≤2 h/d) with family television-use policies and regular nonscreen activities among US school-aged children. Data from the 2007 National Survey of Children's Health were used. The sum of minutes spent on television, videos, video games, and recreational computer use was calculated for children 6 to 17 years old. Bivariate and multivariate logistic regression models were used to calculate relative odds of exceeding American Academy of Pediatrics guidelines and of heavy screen use (>4 h/d) for varying family media-use policies and frequency of alternative activities (physical activity and family meals). In all, 49% of school-aged children had screen time >2 h/d and 16% had screen time >4 h/d. Lower frequency of family meals, presence of TV in the bedroom, absence of rules about TV viewing, and less physical activity were associated with both >2 and >4 hours per day of screen time.