JAMA Pediatrics

In the 1970s, McCracken et al1 described the association between K1 polysaccharide–encapsulated Escherichia coli and neonatal meningitis. During the next several decades, investigators worldwide elaborated the molecular basis of the virulence of extra-intestinal pathogenic E coli (ExPEC), specialized clones variously capable of causing bloodstream, urinary tract, and even central nervous system infections in newborns, children, and adults.2 In addition to polysaccharide capsules such as K1, ExPEC clones routinely encoded adhesins, cytotoxins, and iron-acquisition systems, among other virulence factors.

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Cardiovascular Disease in Former Pediatric Recipients of Growth HormoneAnother Look at Growth Hormone Safety

Adda Grimberg, MD1,2

doi : 10.1001/jamapediatrics.2020.5232

JAMA Pediatr. 2021;175(2):e205232

In this issue of JAMA Pediatrics, Tidblad et al1 report a Swedish nationwide cohort study of 3408 adults who had received growth hormone treatment during childhood from 1985 to 2010 for isolated growth hormone deficiency (GHD), small for gestational age without catch-up growth (SGA), or idiopathic short stature (ISS). Cardiovascular events through 2014 were compared between this register-based cohort and control individuals matched 15:1 for age, sex, and county (n?=?50?036) randomly selected from the Swedish Total Population Register. Data on select covariates were collected from various national health and population registers and linked by the individuals’ unique personal identity numbers. The adjusted hazard ratio for all cardiovascular events was higher in patients than controls overall (1.69; 95% CI, 1.30-2.19), in each indication subgroup, for severe cardiovascular events only, and in particular in females. As the authors state, “Conclusions of causality are still limited and the absolute risk remains low.”

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Autism Spectrum Disorder and the Risk of Substance Use DisorderA Call for Targeted Screening and Prevention in Adolescents

Sarah Ann R. Anderson, MD, PhD1; Marina Catallozzi, MD, MSCE2,3,4

doi : 10.1001/jamapediatrics.2020.5376

JAMA Pediatr. 2021;175(2):e205376

Screening for substance use is a priority in adolescent health care.1 There has long been an acknowledgment of the link between psychiatric diagnoses and substance use disorders (SUDs).2,3 One of the cornerstones of the approaches to decreasing SUDs is to screen for and treat these other illnesses.

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Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children

Summer Rosenstock, PhD, MHS1; Allison Ingalls, MPH1; Reese Foy Cuddy, MPH1; Nicole Neault, MPH1; Shea Littlepage, MSPH1; Lisa Cohoe1; Leonela Nelson, BS1; Kimberlyn Shephard-Yazzie1; Shaneyka Yazzie1; Anna Alikhani, MPH1,2; Raymond Reid, MD1; Anne Kenney, MPH1; Allison Barlow, PhD, MPH, MA1

doi : 10.1001/jamapediatrics.2020.3557

JAMA Pediatr. 2021;175(2):133-142

Importance Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population.

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Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

Russell M. Viner, PhD1; Oliver T. Mytton, PhD2; Chris Bonell, PhD3; G. J. Melendez-Torres, PhD4; Joseph Ward, MBBS1; Lee Hudson, PhD1; Claire Waddington, DPhil5; James Thomas, PhD6; Simon Russell, PhD1; Fiona van der Klis, PhD7; Archana Koirala, MBChB8; Shamez Ladhani, MD9; Jasmina Panovska-Griffiths, DPhil10; Nicholas G. Davies, DPhil3; Robert Booy, MD8; Rosalind M. Eggo, PhD3

doi : 10.1001/jamapediatrics.2020.4573

JAMA Pediatr. 2021;175(2):143-156

Importance The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior.

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Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City

Dani Dumitriu, MD, PhD1,2,3,4; Ukachi N. Emeruwa, MD, MPH2,5; Erin Hanft, MD6; Grace V. Liao, MD6; Elizabeth Ludwig, MD2,7; Lauren Walzer, DO1,2; Brittany Arditi, MD, MSCR2,5; Minna Saslaw, MD1,2; Maria Andrikopoulou, MD, PhD2,5; Tessa Scripps, MD1,2; Caitlin Baptiste, MD2,5; Adrita Khan, MD1,2; Noelle Breslin, MD2,5; David Rubenstein, MD2,6; Lynn L. Simpson, MD2,5; Margaret H. Kyle, BA3; Alexander M. Friedman, MD, MPH2,5; Daniel S. Hirsch, MD2,6; Russell S. Miller, MD2,5; Cristina R. Fern?ndez, MD, MPH1,2; Karin M. Fuchs, MD, MHA2,5; M. Kathleen Keown, MD1,2; Melissa E. Glassman, MD, MPH, IBCLC1,2; Ashley Stephens, MD1,2; Archana Gupta, MD2,6; Sally Sultan, MD1,2; Caroline Sibblies, MD2,6; Susan Whittier, PhD8; Wanda Abreu, MD, IBCLC1,2; Francis Akita, MD2,6; Anna Penn, MD, PhD2,6; Mary E. D’Alton, MD2,7; Jordan S. Orange, MD, PhD2,9; Dena Goffman, MD2,5,7; Lisa Saiman, MD, MPH2,10; Melissa S. Stockwell, MD, MPH1,2,11; Cynthia Gyamfi-Bannerman, MD, MSc2,5

doi : 10.1001/jamapediatrics.2020.4298

JAMA Pediatr. 2021;175(2):157-167

Importance Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies.

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Antibiotic Susceptibility of Escherichia coli Among Infants Admitted to Neonatal Intensive Care Units Across the US From 2009 to 2017

Dustin D. Flannery, DO, MSCE1,2,3,4; Ibukunoluwa C. Akinboyo, MD5; Sagori Mukhopadhyay, MD, MMSc1,2,3; Alison C. Tribble, MD, MSCE6; Lihai Song, MS1,7; Feiyan Chen, PhD1,7; Yun Li, PhD1,8; Jeffrey S. Gerber, MD, PhD1,3,4,9; Karen M. Puopolo, MD, PhD1,2,3

doi : 10.1001/jamapediatrics.2020.4719

JAMA Pediatr. 2021;175(2):168-175

Importance Escherichia coli is a leading cause of serious infection among term and preterm newborn infants. Surveillance of antibiotic susceptibility patterns of E coli among infants admitted to neonatal intensive care units should inform empirical antibiotic administration.

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Assessment of 135?794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States

L. Charles Bailey, MD, PhD1,2,3; Hanieh Razzaghi, MPH1,2,3; Evanette K. Burrows, MPH1,3; H. Timothy Bunnell, PhD4; Peter E. F. Camacho, MS2; Dimitri A. Christakis, MD, MPH5,6; Daniel Eckrich, MLIS4; Melody Kitzmiller, BS7; Simon M. Lin, MD, MBA8; Brianna C. Magnusen, MD9; Jason Newland, MD10; Nathan M. Pajor, MD, MS11,12,13; Daksha Ranade, MPH, MBA5; Suchitra Rao, MD, MSCS14; Olamiji Sofela, MBChB, MMCi15; Janet Zahner, BS12; Cortney Bruno, MSW1; Christopher B. Forrest, MD, PhD1,2,3

doi : 10.1001/jamapediatrics.2020.5052

JAMA Pediatr. 2021;175(2):176-184

Importance There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and infection among pediatric patients across the United States.

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Trends in Use and Perceptions of Nicotine Vaping Among US Youth From 2017 to 2020

Richard Miech, PhD1; Adam Leventhal, PhD2; Lloyd Johnston, PhD1; Patrick M. O’Malley, PhD1; Megan E. Patrick, PhD3; Jessica Barrington-Trimis, PhD2

doi : 10.1001/jamapediatrics.2020.5667

JAMA Pediatr. 2021;175(2):185-190

Importance US adolescent nicotine vaping increased at a record pace from 2017 to 2019, prompting new national policies to reduce access to flavors of vaping products preferred by youth.

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Association of Childhood Growth Hormone Treatment With Long-term Cardiovascular Morbidity

Anders Tidblad, MD, PhD1; Matteo Bottai, PhD, ScD2; Helle Kieler, MD, PhD3; Kerstin Albertsson-Wikland, MD, PhD4; Lars S?vendahl, MD, PhD1

doi : 10.1001/jamapediatrics.2020.5199

JAMA Pediatr. 2021;175(2):e205199

Importance Concerns about the cardiovascular safety of recombinant human growth hormone (rhGH) treatment in childhood have recently been raised; however, long-term studies are limited.

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Risk of Substance Use Disorder and Its Associations With Comorbidities and Psychotropic Agents in Patients With Autism

Jing-Syuan Huang, MD1; Fu-Chi Yang, MD, PhD2; Wu-Chien Chien, PhD3,4,5; Ta-Chuan Yeh, MD6; Chi-Hsiang Chung, PhD3,5; Chia-Kuang Tsai, MD, PhD2; Shih-Jen Tsai, MD, PhD7; Sung-Sen Yang, PhD3,8; Nian-Shen Tzeng, MD6; Mu-Hong Chen, MD, PhD7; Chih-Sung Liang, MD1,8

doi : 10.1001/jamapediatrics.2020.5371

JAMA Pediatr. 2021;175(2):e205371

Importance The risk of substance use disorder (SUD) in patients with autism spectrum disorder (ASD) remains unclear.

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Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder

Irene M. Loe, MD1; Pooja A. Kakar, MD1; Lee M. Sanders, MD, MPH1

doi : 10.1001/jamapediatrics.2020.2218

JAMA Pediatr. 2021;175(2):191-192

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects nearly 1 in 10 children and significantly affects academic achievement, well-being, and social interactions.1 Although ADHD is usually diagnosed in childhood and continues through adolescence and adulthood,2 many children remain untreated or undertreated.3 Comorbid conditions, such as learning and language disorders, anxiety, depression, oppositional defiant disorder, and conduct disorder, are commonly associated with ADHD and often missed.

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One Year Later, How Does COVID-19 Affect Children?

Lindsay A. Thompson, MD, MS1,2; Sonja A. Rasmussen, MD, MS1,3,4

doi : 10.1001/jamapediatrics.2020.5817

JAMA Pediatr. 2021;175(2):216

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Frequency of Children vs Adults Carrying Severe Acute Respiratory Syndrome Coronavirus 2 Asymptomatically

Gregorio P. Milani, MD; Ilaria Bottino, MD2; Alessia Rocchi, MD1; Paola Marchisio, MD3; Silvia Elli, MD2; Carlo Agostoni, MD4; Giorgio Costantino, MD5

doi : 10.1001/jamapediatrics.2020.3595

JAMA Pediatr. 2021;175(2):193-194

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Polysubstance Involvement in Opioid Overdose Deaths in Adolescents and Young Adults, 1999-2018

Jamie K. Lim, MD1; Joel J. Earlywine, BA2; Sarah M. Bagley, MD, MSc1; Brandon D. L. Marshall, PhD3; Scott E. Hadland, MD, MPH, MS1

doi : 10.1001/jamapediatrics.2020.5035

JAMA Pediatr. 2021;175(2):194-196

From 1999 to 2016, opioid-related mortality among adolescents and young adults aged 13 to 25 years (referred to as youth) increased 3-fold.1 Opioid overdose deaths in adult populations often involve other substances, particularly benzodiazepines and, increasingly, stimulants.2,3 Little is known about polysubstance involvement in opioid overdose deaths among youth. In this cross-sectional study, we examined national trends in polysubstance-involved opioid overdose deaths among youth in the US.

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Characteristics of Youths Treated With Psychotropic Polypharmacy in the United States, 1999 to 2015

Chengchen Zhang, MPH1; O’Mareen Spence, MPH, PhD1; Gloria Reeves, MD2; Susan dosReis, PhD1

doi : 10.1001/jamapediatrics.2020.4678

JAMA Pediatr. 2021;175(2):196-198

The use of medication from 2 or more psychotropic classes, ie, polypharmacy,1 has increased among US youths2 despite limited evidence of efficacy and mounting safety concerns.3 The US Food and Drug Administration (FDA) approved several psychotropic classes, eg, selective serotonin reuptake inhibitors and second-generation antipsychotics, for expanded use in pediatric populations,4,5 but it is unknown whether this corresponds with the observed increase in psychotropic polypharmacy and who is more likely to receive psychotropic polypharmacy. Our goal was to investigate differences during a 17-year study period in the characteristics of US youths treated with psychotropic polypharmacy and in the psychotropic classes used in combination.

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Prevalence of SARS-CoV-2 Infection in Children Without Symptoms of Coronavirus Disease 2019

Ana Marija Sola, BS1; Abel P. David, MD2; Kristina W. Rosbe, MD3; Atsuko Baba, MD4; Lynn Ramirez-Avila, MD, MSc5; Dylan K. Chan, MD, PhD3

doi : 10.1001/jamapediatrics.2020.4095

JAMA Pediatr. 2021;175(2):198-201

during the coronavirus disease 2019 (COVID-19) pandemic, determination of prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children without symptoms of COVID-19 is critical to guide infection control policy. While estimates have been reported in children undergoing emergency surgery1 and oncologic care,2 these small studies have limited generalizability to large populations of children without symptoms. When children's hospitals resumed elective medical and surgical care in April and May 2020, many implemented routine SARS-CoV-2 testing for children presenting for care not associated with suspicion of COVID-19. Here, we report the prevalence of positive SARS-CoV-2 test results in children without symptoms at 28 children's hospitals across the US.

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Early Formula Supplementation Trends by Race/Ethnicity Among US Children Born From 2009 to 2015

Ruowei Li, MD, PhD1; Cria G. Perrine, PhD1; Erica H. Anstey, PhD1; Jian Chen, MS1; Carol A. MacGowan, MPH, RDN, LD1; Laurie D. Elam-Evans, PhD, MPH2; Deborah A. Galuska, PhD1

doi : 10.1001/jamapediatrics.2020.2670

JAMA Pediatr. 2021;175(2):201-204

Breastfeeding is the best source of nutrition for most infants. It is associated with a reduction in the risk for some health conditions for both infants and mothers.1,2 The American Academy of Pediatrics recommends that infants be fed only human milk for about the first 6 months of life, with continued breastfeeding along with complementary foods for at least 1 year.3 Previous studies have indicated that early formula supplementation is associated with the exclusivity and duration of breastfeeding,4 but, to our knowledge, trend analysis on formula supplementation among US children is lacking. This survey study examines the trends in early formula supplementation by race/ethnicity using data from the National Immunization Survey–Child (NIS-Child) of US children born from 2009 to 2015.

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Validating the Importance of Positive Childhood Experiences on Adult Mental Health

Cynthia L. Gong, PharmD, PhD1; Leah Yieh, MD, MPH1; Joel W. Hay, PhD2

doi : 10.1001/jamapediatrics.2020.0094

JAMA Pediatr. 2021;175(2):204

To the Editor Bethell et al1 find a dose-response association between positive childhood experiences (PCEs) and depression/poor mental health (D/PMH) and adult-reported social/emotional support after accounting for exposure to adverse childhood experiences. In nonrandomized (real-world) data, treatment selection can be biased by unobservable confounders or inadequately measured explanatory variables, including, in this case, drug use additional to alcohol, exercise, income, wealth, education, race/ethnicity, comorbidities, family and friends, community engagement, job stress, sleep, and major life events. In this case, PCEs may serve as a proxy for such unobservable factors, suggesting that the observed adjusted odds ratio of 0.28 (95% CI, 0.21-0.39; P?<?.001) for D/PMH among those reporting 6 to 7 PCEs indeed implies a moderate degree of causality after adjusting for age, race/ethnicity, and annual income.

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Validating the Importance of Positive Childhood Experiences on Adult Mental Health—Reply

Christina Bethell, PhD, MBA, MPH1; Robert Sege, MD, PhD2

doi : 10.1001/jamapediatrics.2020.0097

JAMA Pediatr. 2021;175(2):204-205

In Reply We are delighted that Gong et al, using methods borrowed from economics, confirmed the validity of the associations reported in our article on the association between positive childhood experiences (PCEs) and adult mental health. Although it was a rigorous population sample and both demographic and childhood adversity exposures were controlled for, the 2015 Wisconsin Behavioral Risk Factor Survey data sample size was insufficient to fully explore many other factors. However, extensive sensitivity analyses were conducted when developing the models for our study that did consider many other variables, such as health behaviors and other health conditions. In cases where samples allowed models to be fit, inclusion of these variables did not meaningfully alter estimated associations for the PCEs variable of interest and in most cases were either not statistically significant or associations were very small. No effect sizes for any additional variables were observed that approached the E-value Gong et al suggest would be required to eliminate the observed effect of PCEs. In most cases, additional variables associated with health behaviors and concurrent health conditions were not included owing to lack of sufficient sample, lack of significance or effect on PCEs associations, as well owing to concerns about multicollinearity or simultaneity. We do note that our explorations were not exhaustive and could not take into account potentially critical unobserved factors, such as noted in the letter. Clearly, although the main results are robust, further research and longitudinal study designs are needed. We hope that Gong et al will continue to bring novel methodologic techniques and approaches to better elucidate the association between a full range of childhood experiences and subsequent adult health. We are enriched by this letter’s contribution to our own work in this area.

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Comparing the Roles of Omalizumab and Ultraviolet Therapy in Treating Severe Pediatric Atopic Dermatitis

Jewel Park, BSc1

doi : 10.1001/jamapediatrics.2020.0960

JAMA Pediatr. 2021;175(2):205

To the Editor In their study, Chan et al1 report the effectiveness of omalizumab in treating severe pediatric atopic dermatitis, with significant clinical benefit. While these encouraging results suggest that omalizumab may be a viable treatment option for this patient group, the Editorial2 on this study succinctly raised the issue of cost-effectiveness because the cost of omalizumab administration could amount to greater than $100?000 per year. Thus, there needs to be a strong rationale for using omalizumab in favor of other treatment options.

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Comparing the Roles of Omalizumab and UV Therapy in Treating Severe Pediatric Atopic Dermatitis—Reply

Susan Chan, MH, MD1,2; Gideon Lack, MB, BCh2

doi : 10.1001/jamapediatrics.2020.0969

JAMA Pediatr. 2021;175(2):206

In Reply We thank Park for the comments on our study.1 We would like to point out that the Atopic Dermatitis Anti-IgE Pediatric Trial (ADAPT) did not set out to study the role of UV (UV) therapy in atopic dermatitis (AD) or compare it with omalizumab in children. The study on UV therapy2 quoted by Park was not a randomized clinical trial. Therefore, the results are not directly comparable and should be interpreted with caution.

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Apgar Score—It Is Time to Avoid Pain

Carlo V. Bellieni, MD1

doi : 10.1001/jamapediatrics.2020.2551

JAMA Pediatr. 2021;175(2):206-207.

To the Editor In a Viewpoint, Rüdiger and Rozycki1 invite us to reconsider the use of the Apgar score, with all its flaws. In particular, they invite readers to send their proposal for a new tool to be used at birth, aimed to assess more reliably the possible outcomes for an infant. I hope this future new tool would provide respect for an infant with regard to one point: pain. The original papers by Virginia Apgar did specify how to assess the parameters of her score, in particular “reflex irritability,” and that was not reassuring. She wrote that “The usual testing method was suctioning the oropharynx and nares with a soft rubber catheter which called forth a response of facial grimaces, sneezing or coughing.”2 As anyone can understand, this is inapplicable today: airway aspiration is discouraged in most infants by the current guidelines3 because, among other drawbacks, it provokes unnecessary pain. Thus, while most studies that use the Apgar score fail to assess how they score this specific item, some, considering the aforementioned objections about suctioning, have nonetheless proposed other types of painful stimulations.4 I underline that unnecessary pain should always be proscribed, in particular infants’ pain; even single and apparently innocent episodes of procedural pain can lead to ominous consequences.5 I have analyzed neonatal literature and published several articles on how frequent the use of unnecessary pain was in infants in research trials and I propose that provoking pain should not be included in the development of a new prognostic tool to be used at birth, at least for healthy infants. In the case of infants who need supportive or resuscitative maneuvers, the level of reactivity to pain might be calculated, although it may be difficult to determine a single potentially painful maneuver (eg, suctioning or intubation) that would be routinely performed in each of these infants. Nonetheless, I argue that no pain should be provoked purposely either for research purposes or for prognostic assessment.

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Apgar Score—It Is Time to Avoid Pain—Reply

Mario Rüdiger, MD1; Henry J. Rozycki, MD2

doi : 10.1001/jamapediatrics.2020.2560

JAMA Pediatr. 2021;175(2):207

In Reply In the years since Dr Apgar’s score was published,1 our understanding of the sequence of physiological events occurring during the transition from intrauterine to extrauterine life has progressed. This knowledge helps inform the assessments and procedures that constitute the Neonatal Resuscitation Program.2 Oxygenation and changes in circulation culminate in tissue oxygen delivery. A score should reflect those steps. We assume that Apgar chose reflex irritability, which was a sneeze, grimace, or other response to having something stuck up the infant’s nose, as an indication that the brain was receiving sufficient oxygen and perfusion to do its functions. After routine suctioning was dropped as a standard maneuver during resuscitation, a variety of other stimuli, equally irritating, have been substituted.

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High-Flow Nasal Cannula as Rescue Therapy in Bronchiolitis

Sharon O’Brien, BN1,2; Franz E. Babl, MD, MPH, DMedSc3,4; Stuart R. Dalziel, PhD5

doi : 10.1001/jamapediatrics.2020.2563

JAMA Pediatr. 2021;175(2):207-208

To the Editor We read with interest the Viewpoint “High-Flow Nasal Cannula Therapy for Pediatric Patients With Bronchiolitis: Time to Put the Horse Back in the Barn”1 and thank the author for her review that broadly agrees with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network interpretation that the data from the 2 published randomized clinical trials (RCTs)2,3 support the use of high-flow nasal cannula (HFNC) therapy in infants with hypoxia where standard oxygen therapy has failed.4

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High-Flow Nasal Cannula as Rescue Therapy in Bronchiolitis—Reply

Shawn L. Ralston, MD, MS1

doi : 10.1001/jamapediatrics.2020.2579

JAMA Pediatr. 2021;175(2):208

In Reply The point made by O’Brien et al in response to the Viewpoint “High-Flow Nasal Cannula Therapy for Pediatric Patients With Bronchiolitis: Time to Put the Horse Back in the Barn”1 around the safety of high-flow nasal cannula (HFNC) is quite valid and well taken. The risks posed by HFNC use in most clinical settings are likely quite low, although they are certainly not zero.2,3 Magnitude of risk aside, the relevant question in this situation could be posed as follows: if a patient does not clearly stand to benefit from a therapeutic strategy, should we accept even small risks from its use? This is a particularly salient question given the context of increasing use of HFNC in bronchiolitis without evidence of benefit, at least in North America.4,5 If one considers unnecessary cost as a harm, we can draw an even stronger conclusion that it is in the patient’s best interest to avoid early use of HFNC in bronchiolitis because most patients can do so without any harm at all.1

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Proton Pump Inhibitors and Fractures During Growth

Toshihiro Sugiyama, MD, PhD1

doi : 10.1001/jamapediatrics.2020.2554

JAMA Pediatr. 2021;175(2):208-209

To the Editor In their timely and important large cohort study that investigated children younger than 18 years for a median follow-up period of 2 years, Wang et al1 found an increased risk of fractures (hazard ratio [HR], 1.11; 95% CI, 1.06-1.15) among users vs nonusers of proton pump inhibitors (PPIs).1 I fully agree with the authors that we should consider the risk/benefit of PPI use, while careful interpretation of the topic is needed.2 Here, I would like to point out that the authors’ results1 appear to be compatible with findings in adults from a randomized controlled trial3 with a median follow-up of 3 years and a cohort study4 with a median follow-up of 5 years, both of which suggested no causal association between PPI use and fracture risk.

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Proton Pump Inhibitors and Fractures During Growth—Reply

Yun-Han Wang, MSc, BPharm1; Bj?rn Pasternak, MD, PhD1,2

doi : 10.1001/jamapediatrics.2020.2570

JAMA Pediatr. 2021;175(2):209-210

In Reply We greatly appreciate the comments from Sugiyama on our study1 evaluating the association between proton pump inhibitor (PPI) use and risk of fracture in children. We agree that the results need to be interpreted carefully and that additional research is needed.

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Coronavirus Disease 2019 and Effects of School Closure for Children and Their Families

Michele Poletti, PsyD1; Andrea Raballo, MD, PhD2,3

doi : 10.1001/jamapediatrics.2020.3586

JAMA Pediatr. 2021;175(2):210

To the Editor Risks for mental health of children and adolescents in the era of the coronavirus disease 2019 (COVID-19) pandemic, owing to school closure and quarantine, have been delineated by Golberstein et al.1 We further extend their implications of school closure for children and their families, an issue that undergoes a deafening silence in the public debate.

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Coronavirus Disease 2019 and Effects of School Closure for Children and Their Families

Janessa M. Graves, PhD, MPH1; Jessica L. Mackelprang, PhD2; Demetrius A. Abshire, PhD3

doi : 10.1001/jamapediatrics.2020.3589

JAMA Pediatr. 2021;175(2):210-211

To the Editor The coronavirus disease 2019 (COVID-19) pandemic will have major implications on the mental health of children and adolescents. To address gaps in mental health care associated with COVID-19, Golberstein et al1 propose technology-enabled modalities, such as telehealth (ie, telemental health), as a potential solution.1 While acknowledging that some schools and families may lack access to technology to support telehealth and remarking that existing inequities must not be worsened,1 the authors missed an opportunity to note that in rural areas, where youth mental health needs are arguably most profound, limited broadband accessibility may preclude use of telehealth services entirely.

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Coronavirus Disease 2019 and Effects of School Closure for Children and Their Families—Reply

Ezra Golberstein, PhD1; Hefei Wen, PhD2; Benjamin F. Miller, PsyD3

doi : 10.1001/jamapediatrics.2020.3598

JAMA Pediatr. 2021;175(2):211-212

In Reply Coronavirus disease 2019 (COVID-19) continues to highlight the critical importance of addressing mental health in children and adolescents and the foundational role of schools. In our Viewpoint,1 we highlighted 3 policy areas that deserved attention.

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Errors in Figure

doi : 10.1001/jamapediatrics.2020.4460

JAMA Pediatr. 2021;175(2):212

the Research Letter titled “Prevalence of SARS-CoV-2 Infection in Children Without Symptoms of Coronavirus Disease 2019,”1 published online August 25, 2020, contained errors in Figure 1. The labels for 1.0 and 1.5 on the y-axis of the forest plot graph were reversed. Also, the square indicating the prevalence for site 14 was displaced from its true value, 2.21%, to approximately 2.75%; this square was also larger than it should have been. The errors have been corrected.

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Missing Funding Information

doi : 10.1001/jamapediatrics.2020.4907

JAMA Pediatr. 2021;175(2):212

in the Original Investigation titled “Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis,”1 published online September 25, 2020, the Funding/Support and Role of the Funder/Sponsor sections were inadvertently omitted by the author. The following text was added: “Funding/Support: Dr Eggo was supported by grant MR/S003975/1 from Health Data Research UK and grant MC_PC 19065 from the Medical Research Council” and “Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.” Additionally, the degree for author Jasmina Panovska-Griffiths was updated from PhD to DPhil. This article was corrected online.

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Error in Figure 1

doi : 10.1001/jamapediatrics.2020.5951

JAMA Pediatr. 2021;175(2):212

the Original Investigation titled “Risk of Electrolyte Disorders in Acutely Ill Children Receiving Commercially Available Plasmalike Isotonic Fluids: A Randomized Clinical Trial,”1 published online October 26, 2020, was corrected to fix 2 incorrect values in Figure 1. This article was corrected online.

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Errors in the Discussion and Funding/Support Sections

doi : 10.1001/jamapediatrics.2020.6053

JAMA Pediatr. 2021;175(2):212

in the Original Investigation titled, “Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Clinical Trial,” which published online November 9, 2020, in JAMA Pediatrics,1 there was an error in the Discussion section and in the Funding/Support section. In the Discussion section, the mean zBMI for the intervention infants should be 0.61 (73rd percentile) not 0.62 (73rd percentile). The primary funder of the study was Healthy Eating Research, a national program of the Robert Wood Johnson Foundation (grant 74132). This article was corrected online.

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Error in Additional Contributions

doi : 10.1001/jamapediatrics.2020.6059

JAMA Pediatr. 2021;175(2):212

in the Viewpoint entitled “Deimplementation in Pediatrics: Past, Present, and Future,”1 the degree of the individual acknowledged in Additional Contributions was incorrect. His name should have appeared as Matthew Schefft, DO, instead of Matthew Schefft, MD. This article was corrected online.

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Error in Table 4

doi : 10.1001/jamapediatrics.2020.6111

JAMA Pediatr. 2021;175(2):212

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JAMA Pediatrics

doi : 10.1001/jamapediatrics.2020.4145

JAMA Pediatr. 2021;175(2):115

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