Pediatrics

Routine car seat tolerance screening did not improve postdischarge outcomes

This systematic review and meta-analysis evaluated predischarge car seat tolerance screening (CSTS) for preterm and at-risk term infants across 21 studies. Three large nonrandomized intervention studies including 54,358 infants found no reduction in 30-day readmissions with CSTS vs no CSTS (odds ratio, 1.05; 95% CI, 0.86-1.28). There was also no observed benefit for combined 30-day mortality or readmission (odds ratio, 1.17; 95% CI, 0.95-1.43). First CSTS failure occurred in about 9 per 100 infants, with high repeat-test failure rates, potentially prolonging hospitalization without proven benefit. The absence of randomized trials and lack of outcome improvement call into question routine CSTS as a universal discharge requirement. 1

Early eczema, other atopy, delayed solids, and antibiotics drive childhood food allergy risk

This large systematic review and meta-analysis synthesized 190 studies with 2.8 million children to clarify early-life food allergy risk factors. Food allergy incidence to age 6 years, confirmed by food challenge, was approximately 4.7%. Infants with early atopic conditions, especially eczema, allergic rhinitis, and wheeze, had markedly higher odds of food allergy, with substantial absolute risk increases. Delayed introduction of solid foods, including peanut after 12 months, and early-life antibiotic exposure were consistently associated with increased food allergy risk. Male sex, firstborn status, family history of food allergy, parental migration, and self-identified Black race modestly increased risk, highlighting social and biologic determinants. 2

Unintentional prescription ingestions remain a significant cause of pediatric ED visits

This cross-sectional JAMA Pediatrics study estimated annual US emergency department visits and hospitalizations from unintentional oral prescription medication exposures in young children. The analysis focused on dispensed outpatient drugs and identified specific prescription medications most frequently implicated in these events. Findings underscore that prescription medications, beyond over-the-counter products, are major drivers of pediatric poisoning encounters. Results support reinforcing anticipatory guidance on secure storage and blister or unit-dose packaging for high-risk drugs in early childhood. 3

Part C early intervention associated with better third-grade academic outcomes

This retrospective cohort linked New York City birth records with public school data for 214,370 children through third grade. Only 6.1% received Part C early intervention (EI) services before age 3 years, indicating underuse relative to developmental disability prevalence. After propensity score matching, EI recipients had higher third-grade English language arts scores and were more likely to meet standards in both math and ELA. Benefits were greater among children requiring special education, from lower socioeconomic households, or born to immigrant mothers. These findings support timely referral to formal EI services for moderate to severe developmental delays and advocacy to expand program reach. 4