Young US Children Research Articles

Parental Health and Flourishing Among Young US Children.

This cross-sectional study investigates the association between parental health and flourishing among children aged 6 months to 5 years in the US.

Adverse Childhood Experiences and Developmental Delay in Young US Children.

Adverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships. In this cross-sectional analysis of nationally-representative data from the 2017-2018 National Survey of Children's Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3-5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics. We found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17-3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25-4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33-1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57-2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs. Children with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.

Do Multivitamin/Mineral Dietary Supplements for Young Children Fill Critical Nutrient Gaps?

BackgroundNearly a third of young US children take multivitamin/mineral (MVM) dietary supplements, yet it is unclear how formulations compare with requirements. ObjectiveDescribe the number and amounts of micronutrients contained in MVMs for young children and compare suggested amounts on product labels to micronutrient requirements. DesignCross-sectional. SettingAll 288 MVMs on the market in the United States in the National Institutes of Health’s Dietary Supplement Label Database in 2018 labeled for children 1 to <4 years old. Main outcome measuresNumber of MVM products and amounts per day of micronutrients in each product suggested on labels compared with requirements represented by age-appropriate Daily Values (DV). Micronutrients of public health concern identified by the Dietary Guidelines for Americans (DGA) 2015-2020 (DGA 2015) and DGA 2020-2025 (DGA 2020) or those of concern for exceeding the upper tolerable intake levels. Statistical analysesNumber of products and percent DV per day provided by each micronutrient in each product. ResultsThe 288 MVMs contained a mean of 10.1 ± 2.27 vitamins and 4.59 ± 2.27 minerals. The most common were, in rank order, vitamins C, A, D, E, B6, B12; zinc, biotin, pantothenic acid, iodine, and folic acid. For micronutrients denoted by the DGA 2015 and DGA 2020 of public health concern, 56% of the 281 products containing vitamin D, 4% of the 144 with calcium, and none of the 60 containing potassium provided at least half of the DV. The upper tolerable intake level was exceeded by 49% of 197 products with folic acid, 17% of 283 with vitamin A, and 14% of 264 with zinc. Most MVMs contained many of 16 other vitamins and minerals identified in national surveys as already abundant in children’s diets. ConclusionsA reexamination of the amounts and types of micronutrients in MVMs might consider formulations that better fill critical gaps in intakes and avoid excess.

Nutrient Intake Adequacy from Food and Beverage Intake of US Children Aged 1–6 Years from NHANES 2001–2016

The early years, between the ages of one and six, are a period of rapid physical, social and cognitive growth and a nutritionally adequate diet is an important factor for optimum development. We investigated the micronutrient adequacy and status of young US children aged 1–6 years (n = 9848) using 24-h dietary recall interviews completed by parents and caregivers participating in the National Health and Nutrition Examination Survey (NHANES) 2001–2016. data. The proportion of the sample not meeting the Dietary Reference Intakes (DRI) increased with increasing age and was most pronounced for calcium. Despite adequate iron intake, 7.4% and 2.5% had signs of iron deficiency and anemia based on serum ferritin and hemoglobin levels, with younger children and WIC participants at most risk and Non-Hispanic Black children the least. Vitamin B6 intake was adequate, but 6.4% had serum pyridoxal-5-phosphate deficiency. For vitamin E, 69% had intakes below the estimated average requirement (EAR), yet serum deficiency was only detected in 0.9%. Vitamin D intake was inadequate for 87%, but true deficiency may be overestimated. Mean DHA intake was 24 mg/d, well below expert recommendations of 70–100 mg/day. Iron and vitamin B6 deficiency and inadequate calcium, fiber, choline, potassium and DHA intakes are a concern for a significant percentage of young children. The discrepancy between nutrient intakes and serum deficiency levels needs to be further investigated.

A hidden vulnerable population: Young children up-to-date on vaccine series recommendations except influenza vaccines.

Very young children (under 2 years old) have high risk for influenza-related complications. Children 6 months or older in the US are recommended to receive influenza vaccination annually, yet uptake is substantially lower than other routinely-recommended vaccines. Existing nationally-representative studies on very young child influenza vaccine uptake has several limitations: few examine provider-verified influenza vaccination (relying on parental report), few contain parental vaccine attitudes variables (known to be crucial to vaccine uptake), and none to our knowledge consider intersectionality of social disadvantage nor how influenza vaccine determinants differ from those of other recommended vaccines. This nationally-representative study examines provider-verified data on 7,246 children aged 6-23 months from the most recent (2011) National Immunization Survey to include the restricted Parental Concerns module, focusing on children up-to-date on a series of vaccines (the 4:3:1:3:3:1:4 series) but not influenza vaccines ("hidden vulnerability to influenza"). About 71% of children were up-to-date on the series yet only 33% on influenza vaccine recommendations by their second birthday; 44% had hidden vulnerability to influenza. Independent of parental history of vaccine refusal and a myriad of health services use factors, no parental history of delaying vaccination was associated with 7.5% (2.6-12.5) higher probability of hidden vulnerability to influenza despite being associated with 15.5% (10.8-20.2) lower probability of being up-to-date on neither the series nor influenza vaccines. Thus, parental compliance with broad child vaccine recommendations and lack of vaccine hesitancy may not indicate choice to vaccinate children against influenza. Examination of intersectionality suggests that maternal college education may not confer improved vaccination among non-Hispanic Black and Hispanic children despite that it does for non-Hispanic White children. Policymakers and researchers from public health, sociology, and other sectors need to collaborate to further examine how vaccine hesitancy and intersectional social disadvantage interact to affect influenza vaccine uptake in young US children.

Examining Nutrient Adequacy, Iron Deficiency, and Anemia in US Children 1–3 Years of Age Using Data From NHANES 2001–2016

Abstract Objectives To assess nutrient intake adequacy from foods and beverages and to examine iron deficiency and anemia status in young US children. Methods National Health and Nutrition Examination Survey (NHANES) data for 2001–2016 in children 1–3 years of age were analyzed for mean dietary intake of individual nutrients (n = 5579), serum ferritin (n = 2498), and hemoglobin (n = 3919). Separate analyses for age groups 1–3 and 1–2 years were performed for gender combined and males/females separately. Dietary adequacy was assessed by comparing against estimated average requirements (EARs) and adequate intakes (AIs) as established by the IOM, as well as global recommendations for docosahexaenoic acid (DHAGR). Iron deficiency and anemia status were determined using ferritin (&amp;lt;10 ng/mL) and hemoglobin (&amp;lt;11 g/dL), respectively. Results The percentage of the population with intakes below the EAR for vitamin D, vitamin E, calcium, and iron were 82.7%, 70.9%, 3.6%, and 0.87% of children 1–3 years gender combined, respectively. Only 1% of children in this age group had fiber intakes greater than the AI. In addition, 97.6%-99.3% of these children did not meet the DHAGR of 70–100 mg/day. Similar results were found in the other age/gender groups. Compared to males, females had lower intakes of vitamin D, calcium and fiber, regardless of age. An estimated 6.9% of all children 1–3 years and 8.5% of all children 1–2 years appeared to be iron deficient. In comparison with other races/ethnicities sampled, Hispanic children appeared to have the highest (8.9% 1–3 years; 11.6% 1–2 years) and Non-Hispanic Black children (4.2% 1–3 years; 6.0% 1–2 years) the lowest rates of iron deficiency. Furthermore, 3.5% of all children 1–3 years and 4.3% of all children 1–2 years met the criteria for anemia. Conclusions Overall, dietary intake of US children 1–3 years of age appears to be adequate with the exception of vitamin D, vitamin E, calcium and fiber. Although iron intake was found to be adequate in this population, iron deficiency, as indicated by ferritin status, was still identified at 6.9% of children 1–3 years. Anemia as indicated by hemoglobin status was also identified. DHA intake was below recommendations for nearly all children. More research is needed to investigate these findings. Funding Sources Mead Johnson Nutrition/RB.

Patterns of Influenza Vaccination and Vaccine Effectiveness Among Young US Children Who Receive Outpatient Care for Acute Respiratory Tract Illness

The burden of influenza among young children is high, and influenza vaccination is the primary strategy to prevent the virus and its complications. Less is known about differences in clinical protection following 1 vs 2 doses of initial influenza vaccination. To describe patterns of influenza vaccination among young children who receive outpatient care for acute respiratory tract illness in the US and compare vaccine effectiveness (VE) against medically attended laboratory-confirmed influenza by number of influenza vaccine doses received. This test-negative case-control study was conducted in outpatient clinics, including emergency departments, at 5 sites of the US Influenza Vaccine Effectiveness Network during the 2014-2015 through 2017-2018 influenza seasons. The present study was performed from November 5, 2014, to April 12, 2018, during periods of local influenza circulation. Children aged 6 months to 8 years with an acute respiratory tract illness with cough who presented for outpatient care within 7 days of illness onset were included. All children were tested using real-time, reverse-transcriptase polymerase chain reaction for influenza for research purposes. Vaccination in the enrollment season with either 1 or 2 doses of inactivated influenza vaccine as documented from electronic medical records, including state immunization information systems. Medically attended acute respiratory tract infection with real-time, reverse-transcriptase polymerase chain reaction testing for influenza. Of 7533 children, 3480 children (46%) were girls, 4687 children (62%) were non-Hispanic white, and 4871 children (65%) were younger than 5 years. A total of 3912 children (52%) were unvaccinated in the enrollment season, 2924 children (39%) were fully vaccinated, and 697 children (9%) were partially vaccinated. Adjusted VE against any influenza was 51% (95% CI, 44%-57%) among fully vaccinated children and 41% (95% CI, 25%-54%) among partially vaccinated children. Among 1519 vaccine-naive children aged 6 months to 2 years, the VE of 2 doses in the enrollment season was 53% (95% CI, 28%-70%), and the VE of 1 dose was 23% (95% CI, -11% to 47%); those who received 2 doses were less likely to test positive for influenza compared with children who received only 1 dose (adjusted odds ratio, 0.57; 95% CI, 0.35-0.93). Consistent with US influenza vaccine policy, receipt of the recommended number of doses resulted in higher VE than partial vaccination in 4 influenza seasons. Efforts to improve 2-dose coverage for previously unvaccinated children may reduce the burden of influenza in this population.

Neurotoxicity of general anesthetics in children: evidence and uncertainties.

Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities. Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures. Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.

Skipping breakfast is associated with lower diet quality in young US children.

Breakfast consumption has been shown to impact children's growth and development, but the influence of breakfast skipping on total daily intakes is not known. The purpose of this study was to examine the differences in nutritional intakes and food consumption between children who consume breakfast versus those who do not. Dietary recall data were assessed for 2-year-old to 5-year-old children (n = 3443) and 6-year-old to 12-year-old children (n = 5147) from NHANES 2005-2012. Dietary intakes and diet quality scores were compared across breakfast consumption and skipping with means and 95% confidence interval. Children who skipped breakfast on the day of intake had significantly lower energy intakes for the total day (5911 vs 6723 kJ) but had greater energy intakes from non-breakfast meals and snacks. Children who skipped breakfast consumed nearly 40% of the day's intake (2332 kJ of 5911 kJ) from snacks, with 586 kJ from snacks as added sugars. Breakfast skipping was also related to significantly lower intakes of fiber, folate, iron, and calcium intakes. Overall diet quality scores, as well as fruit, whole fruit, whole grains, dairy and empty calorie subscale scores were significantly better in children who ate breakfast. Children who skipped breakfast presented poorer overall diet quality and lower total intakes commonly obtained at breakfast. To address missed opportunities, nutrition professionals should encourage children's consumption of a nutritious breakfast to support overall diet quality.

Dietary patterns of early childhood and maternal socioeconomic status in a unique prospective sample from a randomized controlled trial of Prenatal DHA Supplementation.

BackgroundDietary habits established in early childhood and maternal socioeconomic status (SES) are important, complex, interrelated factors that influence a child’s growth and development. The aim of this study was to define the major dietary patterns in a cohort of young US children, construct a maternal SES index, and evaluate their associations.MethodsThe diets of 190 children from a randomized, controlled trial of prenatal supplementation of docosahexaenoic acid (DHA) were recorded at 6-mo intervals from 2-4.5 years by 24-h dietary recall. Hierarchical cluster analysis of age-adjusted, average daily intake of 24 food and beverage groups was used to categorize diet. Unrotated factor analysis generated an SES score from maternal race, ethnicity, age, education, and neighborhood income.ResultsWe identified two major dietary patterns: “Prudent” and “Western.” The 85 (45%) children with a Prudent diet consumed more whole grains, fruit, yogurt and low-fat milk, green and non-starchy vegetables, and nuts and seeds. Conversely, those with a Western diet had greater intake of red meat, discretionary fat and condiments, sweet beverages, refined grains, French fries and potato chips, eggs, starchy vegetables, processed meats, chicken and seafood, and whole-fat milk. Compared to a Western diet, a Prudent diet was associated with one standard deviation higher maternal SES (95% CI: 0.80 to 1.30).ConclusionsWe found two major dietary patterns of young US children and defined a single, continuous axis of maternal SES that differed strongly between groups. This is an important first step to investigate how child diet, SES, and prenatal DHA supplementation interact to influence health outcomes.Trial registration NCT00266825. Prospectively registered on December 15, 2005Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0729-0) contains supplementary material, which is available to authorized users.

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children.

To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.

Characteristics of Print in Books for Preschool Children.

Children begin to learn about the characteristics of print well before formal literacy instruction begins. Reading to children can expose them to print and help them learn about its characteristics. This may be especially true if the print is visually salient, for studies suggest that prereaders pay more attention to such print than to print that is visually less salient. To shed light on the characteristics of the print that US children see in books, especially those characteristics that may contribute to visual salience, we report a quantitative analysis of 73 books that were chosen to be representative of those seen by preschoolers. We found that print that is visually salient due to color, variation, and other features tends to be more common on the covers of books than in the interiors. It also tends to be more common in recently published books than in older books. Even in recent books, however, the print is much less visually salient than the accompanying pictures. Many studies have examined the behavior of adults and children during shared reading, but little research has examined the characteristics of books themselves. Our results provide quantitative information about this topic for one set of characteristics in books for young US children.

Breastfeeding and coffee consumption in children younger than 2 years in Boston, Massachusetts, USA.

Although introduction of inappropriate foods and liquids in early childhood and their association with breastfeeding is commonly reported in US children, coffee use in very young US children and its association with breastfeeding is not. This study aimed to determine the proportion of 1- and 2-year-olds in an urban population consuming coffee, their rate of consumption, and predictors of consumption, including breastfeeding status. We used data from a prospective cohort study on infant weight gain and diet, and body mass index at age 2. We used bivariate analyses to examine variables associated with coffee consumption at 1 and 2 years and multivariate logistic regression to control for variables of interest. This study included 315 mother-infant dyads. At 1 year, the rate of coffee consumption reported was 2.5%; at 2 years, it was 15.2% and average daily consumption was 1.09 oz (range, 0.01- 4.00 oz). The only characteristic associated with coffee consumption at 1 year was breastfeeding at 1 year (P = .0275), which did not remain significant after controlling for confounding variables. Variables significantly associated with coffee consumption at year 2 were lower maternal education (P = .0016), non-US maternal place of birth (P = .0015), maternal Hispanic ethnicity (P < .0001), infant female sex (P = .0495), and receiving any breast milk at 1 year of age (P = .0189). After multivariate logistic regression, maternal Hispanic ethnicity (P = .0139) and infant female sex (P = .0371) remained significant. Coffee consumption is not uncommon among toddlers in Boston, Massachusetts, USA. After controlling for possible confounding factors, maternal ethnicity and infant sex were significantly associated with this practice.

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008–2011

To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs.

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008-2011

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008-2011

Pediatrics Digest

Pediatrics Digest Summary| October 01 2013 Pediatrics Digest Pediatrics (2013) 132 (4): D1–D5. https://doi.org/10.1542/peds.digest1324 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Pediatrics Digest. Pediatrics October 2013; 132 (4): D1–D5. 10.1542/peds.digest1324 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebral palsy, emergency service, hospital, infant, premature, newborn, trend, encephalopathy, ischemic-hypoxic, hydroxyurea, pertussis, bronchiolitis, methicillin-resistant staphylococcus aureus infections The prevalence of overweight and obesity in US adolescents has increased over the last century. However, recent evidence indicates a potential change in this trend. Parallel trends in adolescent behaviors that drive this epidemic have not been well studied. Analyses of recent data indicate the prevalence of overweight and obesity may be stabilizing. Over the same period, adolescent physical activity, breakfast eating, and fruit and vegetable consumption increased and television viewing and consumption of sweets and sweetened beverages decreased. Studies of psychotropic use in very young US children in the last decade have been limited by the regions, insurance types, or medication classes examined. There is a paucity of recent, nationally representative investigations of US preschool psychotropic use. In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s, then stabilized in the late 2000s. Increased psychotropic use in boys, white children,... You do not currently have access to this content.

Decreasing Prevalence of Obesity Among Young Children in Massachusetts From 2004 to 2008

To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases. We analyzed data from 108 762 well-child visits (36 827 children) at a multisite pediatric practice in eastern Massachusetts during 1999-2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months. By using multivariable logistic regression, we estimated gender-specific obesity trends in 2 separate periods, 1999-2003 and 2004-2008, adjusting for age group, race/ethnicity, health insurance, and practice site. From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004-2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid. Among children aged <6 years at this multisite pediatric practice, obesity prevalence decreased during 2004-2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity.

Young Child Homicide and Accidental Death Rates in the United States, 1940-2005: Classification Issues in Mutually Exclusive Events

Events that are mutually exclusive, collectively exhaustive, and have a constant sum must be negatively correlated. This study examined whether non-motor vehicle accidental deaths and homicides in young US children displayed a period of time when this rule governing mutually exclusive events was applicable. Homicide and non-motor vehicle accident mortality rates in boys and girls, aged 1 to 4 years old, in the United States from 1940 to 2005 were analyzed. Homicide mortality rates increased sharply in young boys when the accident mortality rate dropped to about 25/100,000; and in young girls, when the accident mortality dropped to about 18/100,000. This increase in child homicide mortality rates corresponded to a time period when the sum of homicide rates and non-motor vehicle accident rates in these children were relatively constant, making these rates of unnatural deaths mutually exclusive, collectively exhaustive, and having a nearly constant sum. Homicide rates in young US children were relatively stable both before and after this critical constant sum time period. These findings suggest that the increase in homicide rates in young US children appear to have reflected the necessary negative correlation between mutually exclusive, collectively exhaustive, and constant sum events, rather than an actual increase in societal violence directed against young children.

Baseline estimates of diarrhea-associated mortality among United States children before rotavirus vaccine introduction.

Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed. National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992-2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus. An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992-1998 and 2005-2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually. Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States.

Human Rhinovirus Species Associated With Hospitalizations for Acute Respiratory Illness in Young US Children

The contribution of human rhinovirus (HRV) to severe acute respiratory illness (ARI) is unclear. To assess the association between HRV species detection and ARI hospitalizations. Children <5 years old hospitalized for ARI were prospectively enrolled between December 2003 and April 2005 in 3 US counties. Asymptomatic controls were enrolled between December 2003 and March 2004 and between October 2004 and April 2005 in clinics. Nasal and throat swab samples were tested for HRV and other viruses (ie, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, and influenza virus) by reverse-transcription-polymerase chain reaction, and genetic sequencing identified HRV species and types. HRV species detection was compared between controls and patients hospitalized during months in which controls were enrolled. A total of 1867 children with 1947 ARI hospitalizations and 784 controls with 790 clinic visits were enrolled and tested for HRV. The HRV-A detection rate among participants ≥24 months old was 8.1% in the hospitalized group and 2.2% in the control group (P = .009), and the HRV-C detection rates among those ≥6 months old were 8.2% and 3.9%, respectively (P = .002); among younger children, the detection rates for both species were similar between groups. The HRV-B detection rate was ≤1%. A broad diversity of HRV types was observed in both groups. Clinical presentations were similar among HRV species. Compared with children infected with other viruses, children with HRV detected were similar for severe hospital outcomes and more commonly had histories or diagnoses of asthma or wheezing. HRV-A and HRV-C were associated with ARI hospitalization and serious illness outcomes.