pediatrics

Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults A WikiGuidelines Group Consensus Statement

Nathan Hinkle — Wed, 17 Jun 2026 01:19:59 +0000

Date Added:

June 16, 2026

Journal/Publication:

JAMA Network Open

Publisher:

The American Medical Association

Publication Date:

November 4, 2024

Pages:

1-29

URL:

Guidelines for the Prevention, Diagnosis and Management of Urinary Tract Infections in Pediatrics and Adults A Wiki Guidelines Group Consensus Statement

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

doi:10.1001/jamanetworkopen.2024.44495

Keywords

urinary tract infections

pediatrics

Treatment guidelines

MeSH

urinary tract infections

risk assessment

RPR Commentary: Suggested guidelines from the WikiGuidelines Group for diagnosis and management of children and adults with urinary tract infections. James W. Molds, MD, MPH

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Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.

Objective To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength.

Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches.

Findings A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.

Conclusions and Relevance In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.

Author/s:

Zachary Nelson, Abdullah Tarik Aslan, Nathan P. Beahm

What Parents Need to Know About Sleep in Children

Megan George — Tue, 06 Jan 2026 14:26:08 +0000

Date Added:

January 6, 2026

Journal/Publication:

JAMA Pediatrics

Publication Date:

December 22, 2025

URL:

What Parents Need to Know About Sleep in Children

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jamapediatrics.2025.5376

Keywords

PMID (1):

41428340

MeSH

sleep initiation and maintenance disorders

Information for parents about sleep in children. James W. Mold, MD, MPH

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Half of all children have sleep issues at some point during childhood.

When a child does not sleep well, the entire family feels the impact. Sleep supports growth and development and prevents other illnesses. Poor sleep can lead to daytime irritability, trouble focusing, behavioral issues, and learning difficulties. Poor sleep is also associated with long-term problems, such as obesity, breathing problems, and heart problems.

Childhood sleep problems fall into 4 main categories. The most common is behavioral insomnia. This happens when a child has trouble falling or staying asleep, often because they need a specific habit or aid (like rocking or feeding) to settle. Without this help, they struggle to soothe themselves to sleep.

A second category is parasomnias, which are sleep disturbances like night terrors, sleepwalking, and teeth grinding. Night terrors are sudden episodes in which a child screams or appears panicked early in the night. While frightening to witness, the child is unaware of the episode and will have no memory of it. These are usually harmless and temporary.

A third category is bed-wetting, which is also common up to around age 7 years and is usually normal. If it continues regularly after that, discuss with a health care professional to rule out underlying issues or find strategies to help.

Sleep apnea is the final category and is a more serious condition involving repeated pauses in breathing during sleep. Sleep apnea can be caused by enlarged tonsils or excess weight. Children may snore loudly, gasp, or appear restless at night. This disrupted sleep can affect their mood, behavior, and ability to learn. Some children may need overnight sleep studies to diagnose sleep apnea and provide interventions to decrease lifetime illness.

Speak to your child’s pediatrician if you have concerns. Note if your child snores loudly 3 or more nights per week, especially if they gasp or choke during sleep. Excessive daytime sleepiness, frequent headaches or stomachaches, or sleep consistently lasting less than the recommended amount (less than 9 hours for school-aged children) are also signs that your child may have a more serious sleep condition.

All sleep problems need attention. The best way to support better sleep is to create consistent routines that support sleep, known as good sleep hygiene. Keep the same bedtime and waking time every day, including weekends. Establish a calm wind-down routine (like a bath or quiet reading) for 20 to 45 minutes before bed. Turn off all screens and end exciting activities at least 1 hour before bedtime, and make sure the bedroom is cool, dark, and quiet without televisions and screens. Pay attention to both nighttime signs (like snoring or waking) and daytime behaviors (like crankiness, trouble concentrating, or hyperactivity). For children who have trouble falling asleep on their own, put them to bed when they are drowsy but still awake so they learn how to independently fall asleep. They will need this skill every time they wake up in the middle of the night, which could happen 2 to 3 times. With consistency, many sleep issues improve, helping your child rest well at night and feel their best during the day.

Author/s:

Cynthia-Mae M Hunt, Lindsay A Thompson

What RSV Is and Why Immunization Matters

Megan George — Tue, 04 Nov 2025 15:48:19 +0000

Date Added:

November 4, 2025

Journal/Publication:

JAMA Pediatrics Patient Page

Publication Date:

September 29, 2025

URL:

What RSV Is and Why Immunization Matters

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jamapediatrics.2025.3096

Keywords

pediatrics

RSV

respiratory synytial virus vaccines

immunizations

vaccines

PMID (1):

41021255

MeSH

infant

child

Respiratory Syncytial Virus Infections

Respiratory Syncytial Virus Vaccines* / therapeutic use

Respiratory Syncytial Virus Vaccines* / administration & dosage

Respiration Disorders

Information for parents about RSV. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page describes respiratory syncytial virus (RSV) in children and how to prevent its spread.

Author/s:

Alistair Mukondiwa, Callie L. Brown, Lindsay A. Thompson

Efficacy and Safety of GLP-1 RAs in Children and Adolescents With Obesity or Type 2 Diabetes: A Systematic Review and Meta-Analysis

Megan George — Tue, 16 Sep 2025 13:46:37 +0000

Date Added:

September 16, 2025

Journal/Publication:

JAMA Pediatrics

Publication Date:

September 15, 2025

URL:

Efficacy and Safety of GLP-1 RAs in Children and Adolescents With Obesity or Type 2 Diabetes: A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.3243

Keywords

diabetes

Diabetes and Endocrinology

PMID (1):

40952752

MeSH

diabetes mellitus, type 2

Glycated Hemoglobin

overweight

Glucagon-Like Peptide-1 Receptor Agonists

glucagon-like peptide 1

Prediabetic State

blood pressure

pediatric obesity

Digestive System Diseases

A review of what we know about the use of GLP-1 RAs in children and adolescents. James W. Mold, MD, MPH

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Importance Obesity affects 1 in 5 children and adolescents, increasing the risk of type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are among the few pharmacotherapy options available for this population, necessitating a comprehensive evaluation of efficacy and safety.

Objective To assess the efficacy and safety of GLP-1 RAs in children and adolescents (<18 years) with obesity, prediabetes, or T2D.

Data Sources A systematic search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized clinical trials (RCTs) published from inception until February 28, 2025. Data analysis was completed from January 2025 to April 2025.

Study Selection RCTs comparing GLP-1 RAs to placebo in children and adolescents with obesity, overweight, prediabetes, or T2D with reported safety and efficacy data were included.

Data Extraction and Synthesis Two reviewers independently extracted data on sample size, population, interventions, follow-up, and outcomes. Risk of bias was assessed using version 2 of the Cochrane risk of bias tool (RoB2). Efficacy outcomes (except lipids) were analyzed as estimated treatment differences, lipids as estimated treatment ratios, and safety via rate ratios. A random-effects inverse variance model was used for all outcomes.

Main Outcomes and Measures The primary efficacy outcomes were change in hemoglobin A1c (HbA1c) (in percentage points), fasting glucose (in milligrams per deciliter), body weight (in kilograms), body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), BMI z scores or percentiles, BMI standard deviation score (SDS), lipid outcomes, and blood pressure. Exploratory efficacy outcomes included obstructive sleep apnea and metabolic dysfunction–associated steatohepatitis or metabolic dysfunction–associated steatotic liver disease. Safety outcomes included gastrointestinal adverse effects (GI AEs), infections, hepatobiliary disorders, suicidal ideation or behaviors, depression, hypoglycemia, and adverse event discontinuations.

Results A total of 18 RCTs (11 in obesity, 6 in T2D, and 1 in prediabetes) with 1402 participants (838 GLP-1 RA users and 564 placebo) were included (mean [range] age, 13.7 [6-17] years; 831 female participants (59.3%); median [IQR] treatment duration, 0.51 [0.25-1.00] years). GLP-1 RAs significantly reduced HbA1c (−0.44%; 95% CI, −0.68% to −0.21%), fasting glucose (−9.92 mg/dL; 95% CI, −16.20 to −3.64), body weight (−3.02 kg; 95% CI, −4.98 to −1.06), BMI (−1.45; 95% CI, −2.40 to −0.49), BMI SDS (−0.20; 95% CI, −0.36 to −0.05), BMI percentile (−7.24%; 95% CI, −12.97% to −1.51%), and systolic blood pressure (−2.73 mm Hg; 95% CI, −4.04 to −1.43) and increased GI AE (log[rate ratio] [RR], 0.75). Other AEs, including suicidal ideation or behaviors, showed no significant differences.

Conclusions and Relevance In this systematic review and meta-analysis of 18 trials, GLP-1 RAs significantly improved glycemic, weight, and cardiometabolic outcomes in children and adolescents with T2D or obesity. Available data over a relatively short follow-up suggested suicidal ideation or behaviors were not significantly different, although GI AEs warrant attention in long-term management.

Author/s:

Pareeta Kotecha, Wenxi Huang, Ya-Yun Yeh

Patent Foramen Ovale and Stroke A Review

Hope Smashey — Tue, 29 Jul 2025 17:14:31 +0000

Date Added:

July 29, 2025

Journal/Publication:

JAMA

Publication Date:

July 28, 2025

URL:

Patent Foramen Ovale and Stroke A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.10946

Keywords

Congenital Defects

pediatrics

female

PMID (1):

40720119

MeSH

Apparently patent foramen ovale is a lot more common than many of us thought they were and an important cause of embolic strokes. James W. Mold, MD, MPH

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Importance: A patent foramen ovale (PFO), an opening between the right and left atria during normal fetal development that fails to close after birth, is present in approximately 25% of all adults. Paradoxical embolism, a venous thromboembolism that travels to the systemic circulation typically through a PFO, accounts for about 5% of all strokes and 10% of strokes in younger patients.

Observations: Approximately 50% of patients 60 years or younger with an embolic stroke of undetermined source (cryptogenic stroke) have a PFO, compared with 25% of the general population. The Risk of Paradoxical Embolism (RoPE) score incorporates clinical characteristics (age, history of stroke or transient ischemic attack, diabetes, hypertension, smoking, cortical infarct on imaging) to predict the likelihood that embolic stroke of undetermined source was caused by a PFO. Among patients in the lowest RoPE score category (score <3), PFO prevalence was similar to that in the general population (23%), while PFO prevalence was 77% in patients with a RoPE score of 9 or 10. The PFO-Associated Stroke Causal Likelihood (PASCAL) classification system combines the RoPE score and anatomical criteria from echocardiography (large shunt, atrial septal aneurysm) to classify PFO as the “probable,” “possible,” or “unlikely” cause of otherwise cryptogenic stroke. PFO closure reduces recurrent ischemic stroke in patients 60 years or younger with cryptogenic stroke. In a pooled analysis of 6 trials (3740 patients), the annualized incidence of stroke over a median follow-up of 57 months was 0.47% (95% CI, 0.35%-0.65%) with PFO closure vs 1.09% (95% CI, 0.88%-1.36%) with medical therapy (adjusted hazard ratio, 0.41 [95% CI, 0.28-0.60]). However, the benefits and harms of closure were highly heterogeneous across the trial populations. In patients categorized as PASCAL “probable” (ie, younger patients without vascular risk factors and high-risk PFO anatomical features), there was a 90% decreased relative rate of recurrent ischemic stroke after PFO closure at 2 years (hazard ratio, 0.10 [95% CI, 0.03-0.35]; absolute risk reduction, 2.1% [95% CI, 0.9%-3.4%]). PASCAL “unlikely” patients (eg, older patients with vascular risk factors and no high-risk PFO anatomical features) did not have a lower recurrent stroke rate with PFO closure but had higher risk of procedure- and device-related adverse events, such as atrial fibrillation.

Conclusions and Relevance: Patent foramen ovale is present in approximately 25% of all adults and is a common cause of stroke in young and middle-aged patients. The PASCAL classification system can help guide patient selection for PFO closure. Percutaneous PFO closure substantially reduces the risk of stroke recurrence in well-selected patients younger than 60 years after cryptogenic stroke.

Author/s:

David M. Kent, Andy Y. Wang

Pediatric sialorrhea (drooling)

Erin Blanchette — Tue, 14 May 2024 16:36:41 +0000

Date Added:

May 14, 2024

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

May 12, 2024

Issue:

Volume:

196

Pages:

E624

URL:

Pediatric sialorrhea (drooling)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.231550

Keywords

PMID (1):

38740417

MeSH

child

Sialorrhea / etiology

Sialorrhea

A concise review of the causes and management of drooling in young children. James W. Mold, MD, MPH

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Sialorrhea is common in children with neurologic impairment

Sialorrhea can be normal in children with typical development until age 4 years. It occurs in as many as 44% of children with cerebral palsy.1 It typically results from poor oral motor control and fluctuates alongside the child’s developmental trajectory. Reversible contributors such as nasal obstruction, dental issues, and medication effects (e.g., benzodiazepines and clozapine) should be considered.

Author/s:

Karan Gandhi, Julie E Strychowsky, Breanna A Chen

Eating Family Meals Together at Home

Erin Blanchette — Tue, 26 Mar 2024 16:55:00 +0000

Date Added:

March 26, 2024

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

March 25, 2024

URL:

Eating Family Meals Together at Home

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2023.6669

Keywords

PMID (1):

38526499

MeSH

child development

child

adolescent

Feeding and Eating Disorders

Feeding and Eating Disorders of Childhood/psychology*

Information for parents regarding the benefits of family meals together. James W. Mold, MD, MPH

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Eating meals at home together as a family is important for both parents and children.

Eating dinner together at least 3 or 4 times per week has positive effects on child development and has been linked to children’s lower rates of overweight and obesity, substance abuse, teen pregnancy, depression, and eating disorders; higher self-esteem; and better academic performance. Eating family meals also has nutritional benefits. Families who eat dinner together eat more fruits and vegetables and fewer fried foods and sugary drinks. Family meals also help adults and children learn to like a variety of foods.

Author/s:

Callie L Brown, Melissa C Kay, Lindsay A Thompson

Age and Probability of Spontaneous Umbilical Hernia Closure

Erin Blanchette — Tue, 19 Mar 2024 17:51:29 +0000

Date Added:

March 19, 2024

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

March 11, 2024

URL:

Age and Probability of Spontaneous Umbilical Hernia Closure

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.0087

Keywords

PMID (1):

38466296

MeSH

referral and consultation

A concise report on the probability of spontaneous umbilical hernia closure across ages 0 to 5 years. The figure is particularly helpful. James W. Mold, MD, MPH

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This cohort study of children younger than 6 years uses electronic health records to investigate whether a child’s age is associated with the probability of spontaneous umbilical hernia closure and to refine guidelines for surgical repair.

Author/s:

Katherine He, Dionne A Graham, Louis Vernacchio, Jonathan Hatoun, Laura Patane, Shannon L Cramm, Shawn J Rangel

What Is Childhood Leukemia?

Erin Blanchette — Mon, 19 Feb 2024 16:59:17 +0000

Date Added:

February 19, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 9, 2024

URL:

What Is Childhood Leukemia?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.24648

Keywords

PMID (1):

38334982

MeSH

Bone Marrow

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia

Myeloid

Acute

A summary for patients of our current understanding of childhood leukemia. James W. Mold, MD, MPH

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Childhood leukemia is the most common type of cancer that affects children. Leukemia is a cancer of white blood cells that starts in bone marrow (the soft center part of bones), which produces blood cells. Once a leukemic cell develops, it multiplies quickly in the bone marrow and can prevent healthy blood cells from forming. Leukemic cells can spread to various parts of the body, including the fluid that surrounds the brain and spinal cord (cerebrospinal fluid) and other organs such as the liver and kidneys. The cause of childhood leukemia is usually unknown, but in some rare cases, inherited genetic factors may play a role in development of childhood leukemia.

Author/s:

Jenny Ruiz, Colleen Mathews, Erika Friehling

What Parents Should Know About Gun Safety in the Home and Vehicle

Erin Blanchette — Tue, 14 Nov 2023 20:28:26 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

October 30, 2023

URL:

What Parents Should Know About Gun Safety in the Home and Vehicle

Type:

Patient Education Materials

Format:

Article

DOI (1):

doi:10.1001/jamapediatrics.2023.4668

Keywords

PMID (1):

37902742

MeSH

Information for parents on safe gun storage in homes and vehicles. James W. Mold, MD, MPH

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This Patient Page describes safety measures parents can take to protect children from gun violence.

Guns are now the leading cause of death for children in the US.

Guns are even more lethal than motor vehicle crashes. The reasons for this gun violence increase in children are multiple, including a rapid rise in gun purchases, an increase in depression and anxiety in children and adolescents, and widespread stress from a global pandemic. The causes of these injuries and deaths vary by age. Younger children are more commonly injured unintentionally. Curious toddlers can find guns and fire them quickly. Older children and adolescents are more likely to be harmed by homicide or suicide.

The most important factor for children being injured or killed by guns is having a gun in the home where a child lives or the car where a child rides. Adults must make sure their guns are stored safely to prevent access by a child or adolescent. There are gun locks, safes, and other techniques to promote safer storage. As an additional safety measure, caregivers should strongly consider removing guns entirely from the home or vehicle, especially when children are older than about 11 years. These youths know how to find and access guns, even if they are stored safely. Considering the increase in mood disorders and risk of suicidal behaviors in older children and adolescents, they should not be around guns.

Parents and caregivers should follow the Be SMART framework to improve gun safety:

S: Secure all guns in your home and vehicle.

M: Model responsible behavior around guns.

A: Ask about unsecured guns in other homes.

R: Recognize the role of guns in suicide.

T: Tell others to Be SMART.

Author/s:

Rebecca J. Palmer, Leila H. DeWitt, Lindsay A. Thompson

A retrospective cohort study of 12,306 pediatric COVID‑19 patients in the United States

Devin Evans — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Scientific Reports

Publication Date:

May 13, 2021

Issue:

Volume:

URL:

A retrospective cohort study of 12,306 pediatric COVID‑19 patients in the United States

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1038/s41598-021-89553-1

Keywords

2019 novel coronavirus

coronavirus

PMID (1):

33986390

MeSH

child

2-toluenesulfonamide

delivery of health care

Critical Care

COVID-19

A retrospective analysis of the symptoms and clinical course of over 12,000 children with COVID-19. James W. Mold, Md, MPH

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Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49-2.61]) and Hispanic children (RR 1.31 [95% CI 1.03-1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.

Author/s:

Parcha, V., Booker, K.S., Kalra, R., Kuranz, S., Berra, L., Arora, G., Arora, P.