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The Golden Half Hour in Chronic Pediatric Pain—Feedback as the First Intervention
Neil L. Schechter, MD; Rachael Coakley, PhD; Samuel Nurko, MD, MPH
doi : 10.1001/jamapediatrics.2020.1798
JAMA Pediatr. 2021;175(1):7-8
It is now widely accepted that chronic pain is the result of a dynamic interplay of biopsychosocial factors that generate and maintain it. Thus, the psychological vs organic framework is outdated and inaccurate. Additionally, we know that regardless of where a child experiences chronic pain, most will respond to a rehabilitative model of care that incorporates cognitive-behavioral and physical therapy. Thus, it is essential for clinicians to know how to help a family engage with an evidence-based treatment plan that addresses the biological, psychological, and social factors associated with pain.1
A Defining Moment for Pediatric Primary Care Telehealth
Alexander G. Fiks, MD, MSCE; Brian P. Jenssen, MD, MSHP; Kristin N. Ray, MD, MS
doi : 10.1001/jamapediatrics.2020.1881
JAMA Pediatr. 2021;175(1):9-10
On January 20, 2020, authorities reported the first US case of coronavirus disease 2019 (COVID-19) in Snohomish County, Washington. By March 11, the World Health Organization declared a global pandemic, and on March 13, the US declared a national emergency. On March 18, the American Academy of Pediatrics issued guidance1 suggesting that pediatricians limit preventive care visits to younger children requiring immunization, separate the well-visit and sick-visit spaces and times, and increase telehealth capacity. Following Medicare’s lead, many Medicaid programs and other payers expanded coverage and relaxed stipulations about telehealth use. In-person visit volumes in pediatric primary care practices plummeted, and many practices initiated or dramatically expanded video visits to reach patients and attempt to maintain financial viability. Within weeks, primary care practices and the families they serve had widely adopted virtual primary care.
Baby and Bathwater—A Telehealth Tale
Richard C. Wasserman, MD, MPH
doi : 10.1001/jamapediatrics.2020.2205
JAMA Pediatr. 2021;175(1):11-12
A fictional scenario: a recently retired general academic pediatrician (called Dr 20th), who came of age as a clinician in the last quarter of the 20th century, has read a perceptive, strongly positive JAMA Pediatrics Viewpoint on telehealth. This pediatrician is on a video call with a good friend and former trainee, a primary care pediatrician who is experienced, forward-looking, and trained in the 21st century (called Dr 21st), when the conversation turns to telehealth.
Screening for Psychosocial Functioning as the Eighth Vital Sign
Michael Jellinek, MD; J. Michael Murphy, EdD
doi : 10.1001/jamapediatrics.2020.2005
JAMA Pediatr. 2021;175(1):13-14
Dorland’s Medical Dictionary defines vital signs as “signs of life, specifically: the pulse rate, respiratory rate, body temperature, and often blood pressure of a person.”1 Although pain and oxygenation have been nominated for the role of fifth vital sign, within the context of pediatric well-child visits (WCVs), height, weight, and body mass index have become the de facto fifth, sixth, and seventh vital signs, respectively, as they are customary and core to the mission of pediatrics. Each of these signs screens for a relevant concern, such as fever, hypertension, or obesity. Here, we propose that screening for psychosocial functioning should be acknowledged as the eighth vital sign. Psychosocial problems, with an overall national prevalence ranging from 10% to 20%, are among the most common chronic health disorders of youth and are of major concern to families, beneficial to recognize at an early point, and potentially amenable to treatment.
The Miracle Moment
Nicole S. Torres, MD
doi : 10.1001/jamapediatrics.2020.3592
JAMA Pediatr. 2021;175(1):15
The pictures were a stark reminder of what might have been. There she was: radiant with long, dark hair artfully coiffed. Her torso, cinched at the waist, gave way to cascading yards of white, glimmering fabric. It seemed to billow like clouds. Her eyes sparkled, as did her tiara. It was a far cry from reality: sallow, a short cropped haircut, and a drab hospital gown.
Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)Under the Surface
Roberta L. DeBiasi, MD, MS; Meghan Delaney, DO, MPH
doi : 10.1001/jamapediatrics.2020.3996
JAMA Pediatr. 2021;175(1):16-18
since the global emergence and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initial attention appropriately focused on severely affected adults, who represent the highest proportion of symptomatic infections.1 However, as the pandemic has evolved, a significant effect on children has also become evident.2 Data from multiple affected countries have corroborated that children are clearly susceptible to infection and may develop severe primary and unique secondary inflammatory complications of infection, including multisystem inflammatory syndrome of children.3-5 However, the vast majority of infected children have mild or unrecognized disease, and this population may play important epidemiologic roles by potentiating spread of infection through communities6 and/or boosting herd immunity. Only small numbers of children have been included in prior studies focused on kinetics of viral shedding in the setting of symptomatic or asymptomatic SARS-CoV-2 infection.7-12 To our knowledge, no prior studies have systematically focused on the frequency of asymptomatic infection in children or the duration of symptoms and viral shedding in both asymptomatic and symptomatic children.
Identifying and Improving the Active Ingredients in Pediatric Complex Care
Chris Feudtner, MD, PhD, MPH; Annique K. Hogan, MD
doi : 10.1001/jamapediatrics.2020.5042
JAMA Pediatr. 2021;175(1):e205042
What are key active ingredients in effective pediatric complex care programs? Over the past 2 decades, these programs have increasingly arisen. The landmark report by Mosquera and colleagues1 of a randomized clinical trial of their complex care program found that patients assigned to the intervention arm experienced substantial improvements in various outcome measures, including reduced hospitalizations and hospital days. However, these findings, compelling and consistent with other reports of positive effect,2-6 do contrast with reports of other programs that have demonstrated negative, negligible, or mixed effect.7-9
The Promise of Lifestyle Interventions in Individuals With Genetically Higher Risk for Obesity
Marie-France Hivert, MD, MMSc; Ann Chen Wu, MD, MPH
doi : 10.1001/jamapediatrics.2020.5180
JAMA Pediatr. 2021;175(1):e205180
In this issue of JAMA Pediatrics, Heitkamp et al1 report an innovative study investigating how specific common genetic variants previously reported for their association with body mass index (BMI) may be associated with weight change during an inpatient, intensive lifestyle intervention for children with overweight or obesity. Among 56 selected genetic variants, researchers identified 5 variants that seemed to be associated with weight changes over 4 to 6 weeks.
Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia NervosaA Multicenter Randomized Clinical Trial
Andrea K. Garber, PhD, RD; Jing Cheng, PhD; Erin C. Accurso, PhD; et al.
doi : 10.1001/jamapediatrics.2020.3359
JAMA Pediatr. 2021;175(1):19-27
Importance The standard of care for refeeding inpatients with anorexia nervosa, starting with low calories and advancing cautiously, is associated with slow weight gain and protracted hospital stay. Limited data suggest that higher-calorie refeeding improves these outcomes with no increased risk of refeeding syndrome.
Risk of Electrolyte Disorders in Acutely Ill Children Receiving Commercially Available Plasmalike Isotonic FluidsA Randomized Clinical Trial
Saara Lehtiranta, MD; Minna Honkila, MD, PhD; Merja Kallio, MD, PhD; et al.
doi : 10.1001/jamapediatrics.2020.3383
JAMA Pediatr. 2021;175(1):28-35
Importance The use of isotonic fluid therapy is currently recommended in children, but there is limited evidence of optimal fluid therapy in acutely ill children.
Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm InfantsNoninferiority Randomized Clinical Trial
Ori Hochwald, MD; Arieh Riskin, MD; Liron Borenstein-Levin, MD; et al.
doi : 10.1001/jamapediatrics.2020.3579
JAMA Pediatr. 2021;175(1):36-43
Importance Use of cannulas with long and narrow tubing (CLNT) has gained increasing popularity for applying noninvasive respiratory support for newborn infants thanks to ease of use, perceived patient comfort, and reduced nasal trauma. However, there is concern that this interface delivers reduced and suboptimal support.
Assessment of School Anti-Bullying InterventionsA Meta-analysis of Randomized Clinical Trials
David Fraguas, MD, PhD; Covadonga M. D?az-Caneja, MD, PhD; Miriam Ayora, MD; et al.
doi : 10.1001/jamapediatrics.2020.3541
JAMA Pediatr. 2021;175(1):44-55
Importance Bullying is a prevalent and modifiable risk factor for mental health disorders. Although previous studies have supported the effectiveness of anti-bullying programs; their population impact and the association of specific moderators with outcomes are still unclear.
Association of Coming Out as Lesbian, Gay, and Bisexual+ and Risk of Cigarette Smoking in a Nationally Representative Sample of Youth and Young Adults
Alyssa F. Harlow, MPH; Dielle Lundberg, MPH; Julia R. Raifman, ScD, SM; et al
doi : 10.1001/jamapediatrics.2020.3565
JAMA Pediatr. 2021;175(1):56-63
Importance Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults.
Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018
Sean Esteban McCabe, PhD; Brooke J. Arterberry, PhD; Kara Dickinson; et al.
doi : 10.1001/jamapediatrics.2020.3352
JAMA Pediatr. 2021;175(1):64-72
Importance Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited.
Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea
Mi Seon Han, MD, PhD; Eun Hwa Choi, MD, PhD; Sung Hee Chang, MD; et al.
doi : 10.1001/jamapediatrics.2020.3988
JAMA Pediatr. 2021;175(1):73-80
Importance There is limited information describing the full spectrum of coronavirus disease 2019 (COVID-19) and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection in children.
Cost-effectiveness of Sexually Transmitted Infection Screening for Adolescents and Young Adults in the Pediatric Emergency Department
Mark H. Eckman, MD, MS; Jennifer L. Reed, MD, MS; Maria Trent, MD, MPH; et al.
doi : 10.1001/jamapediatrics.2020.3571
JAMA Pediatr. 2021;175(1):81-89
Importance Adolescents and young adults compose almost 50% of all diagnosed sexually transmitted infection (STI) cases annually in the US. Given that these individuals frequently access health care through the emergency department (ED), the ED could be a strategic venue for examining the identification and treatment of STIs.
Hospital Consultation From Outpatient Clinicians for Medically Complex ChildrenA Randomized Clinical Trial
Ricardo A. Mosquera, MD, MS; Elenir B. C. Avritscher, MD, PhD, MBA; Claudia Pedroza, PhD; et al.
doi : 10.1001/jamapediatrics.2020.5026
JAMA Pediatr. 2021;175(1):e205026
Importance Children with medical complexity (CMC) frequently experience fragmented care. We have demonstrated that outpatient comprehensive care (CC) reduces serious illnesses, hospitalizations, and costs for high-risk CMC. Yet continuity of care for CMC is often disrupted with emergency department (ED) visits and hospitalizations.
Obesity Genes and Weight Loss During Lifestyle Intervention in Children With Obesity
Melanie Heitkamp, PhD; Monika Siegrist, PhD; Sophie Molnos, PhD; et al.
doi : 10.1001/jamapediatrics.2020.5142
JAMA Pediatr. 2021;175(1):e205142
Importance Genome-wide association studies have identified genetic loci influencing obesity risk in children. However, the importance of these loci in the associations with weight reduction through lifestyle interventions has not been investigated in large intervention trials.
What Parents Need to Know About Leaving the Neonatal Intensive Care Unit
Lindsay A. Thompson, MD, MS; Carolyn G. Carter, MD, MS
doi : 10.1001/jamapediatrics.2020.5045
JAMA Pediatr. 2021;175(1):112
Potential Change in Insulin Out-of-Pocket Spending Under Cost-Sharing Caps Among Pediatric Patients With Type 1 Diabetes
Kao-Ping Chua, MD, PhD; Joyce M. Lee, MD, MPH; Rena M. Conti, PhD
doi : 10.1001/jamapediatrics.2020.1065
JAMA Pediatr. 2021;175(1):90-92
to improve insulin affordability, several states and insurers have implemented cost-sharing caps. For example, Colorado implemented a $100 cap for a 30-day insulin supply, while the insurer Cigna implemented a $25 cap.1-3 We estimated the potential change in insulin out-of-pocket spending among privately insured children and young adults with type 1 diabetes if national $25 and $100 caps were implemented.
Prevalence of Spanking in US National Samples of 35-Year-Old Parents From 1993 to 2017
Christopher J. Mehus, PhD, LMFT; Megan E. Patrick, PhD
doi : 10.1001/jamapediatrics.2020.2197
JAMA Pediatr. 2021;175(1):92-93
Spanking has been the subject of considerable research and discussion in popular culture. Reviews and state-of-the-art analyses support an association between corporal punishment (including spanking) and negative outcomes for children.1 Professional organizations (eg, American Academy of Pediatrics) have recently issued statements conveying unequivocal opposition to corporal punishment and support for alternative means of discipline.2
Pediatric Patient and Caregiver Values in Treatment Decision-making for Uncomplicated Appendicitis
Jordan C. Apfeld, MD; Jennifer N. Cooper, MS, PhD; Peter C. Minneci, MD, MHSc; et al.
doi : 10.1001/jamapediatrics.2020.2289
JAMA Pediatr. 2021;175(1):94-96
Nonoperative management (NOM) with antibiotics alone has been shown to be safe for uncomplicated appendicitis in pediatric patients.1-3 Shared decision-making to choose between 2 treatments may be facilitated by a better understanding of how patients and caregivers value the specific risks and benefits of each treatment and how those are associated with their treatment decisions.4 A recent survey of parents of children who were healthy showed that 42% of caregivers preferred NOM for their child’s appendicitis; however, these families were making only a hypothetical treatment decision, and factors affecting their preferences were not solicited.5 Our objective in this study was to compare values regarding the risks and benefits of each treatment option between patient-caregiver dyads who chose surgery vs NOM for the child’s appendicitis.
Saliency-Driven Visual Search Performance in Toddlers With Low– vs High–Touch Screen Use
Ana Maria Portugal, PhD; Rachael Bedford, PhD; Celeste H. M. Cheung, PhD; et al.
doi : 10.1001/jamapediatrics.2020.2344
JAMA Pediatr. 2021;175(1):96-97
during toddlerhood, a peak period of neurocognitive development, increased exposure to sensory stimulation through touch screen use, may influence developing attentional control.1 While TV’s rapidly changing, noncontingent flow of sensory information has been hypothesized to lead to difficulties voluntarily focusing attention,2 video gaming’s contingent and cognitively demanding sensory environments may improve visual processing and attention.3 Toddler touch screen use involves both exogenous attention, driven by salient audio-visual features, and endogenous/voluntary control, eg, video selection and app use.4,5
Intention to Quit Vaping Among United States Adolescents
Tracy T. Smith, PhD; Georges J. Nahhas, PhD, MPH; Matthew J. Carpenter, PhD; et al.
doi : 10.1001/jamapediatrics.2020.2348
JAMA Pediatr. 2021;175(1):97-99
In 2019, 25.2% of high school students in the US reported current use (ie, past 30 days) and 11.7% reported daily use of electronic nicotine products (ie, e-cigarettes, vaping).5 Adolescents who vape are at risk for nicotine addiction, toxicant exposure, and transitioning to cigarettes.1,2 The development, evaluation, and dissemination of evidence-based vaping cessation interventions for adolescents could be critical to curbing the vaping epidemic; however, vaping cessation interventions are not widely disseminated, and existing programs have received little empirical investigation. It is necessary to assess interest in quitting and quit attempts in this population to drive funding and guide treatment development. Further, understanding interest in quitting among groups that experience tobacco-related health disparities, including sociodemographic minorities and individuals with mental health symptoms, could guide development of treatment programs for specific subgroups. This study estimated interest in quitting and past e-cigarette quit attempts among US adolescents who vape. To our knowledge, this is the first such report.
Increase in Incidence of Neonatal Abstinence Syndrome Among In-Hospital Birth in the United States
Kamleshun Ramphul, MD; Stephanie Gonzalez Mejias, MD; Jyotsnav Joynauth, MD
doi : 10.1001/jamapediatrics.2020.1870
JAMA Pediatr. 2021;175(1):99-100
To the Editor We read with great interest the novel way of analyzing the Healthcare Cost and Utilization Project (HCUP) data for neonatal abstinence syndrome (NAS) by Strahan et al.1 They also reported that they were unable to compare past published studies because they adopted the “in-hospital births” restriction in their study. Therefore, we used the 2012 Kids’ Inpatient Database provided by HCUP, Agency for Healthcare Research and Quality (AHRQ), and their partners to compare briefly the key findings of overall incidence, racial/ethnic differences, and primary insurance form using the same selection criteria and appropriate International Classification of Diseases, Ninth Revision (ICD-9) code (https://www.hcup-us.ahrq.gov/kidoverview.jsp).
Increase in Incidence of Neonatal Abstinence Syndrome Among In-Hospital Birth in the United States—Reply
Andrea E. Strahan, PhD; Gery P. Guy, PhD; Jean Y. Ko, PhD
doi : 10.1001/jamapediatrics.2020.1873
JAMA Pediatr. 2021;175(1):100
In Reply We appreciate Ramphul et al sharing estimates of the 2012 rate of in-hospital births with a neonatal abstinence syndrome (NAS) diagnosis. In our study1 of 2016 national incidence and cost estimates for in-hospital births with a NAS diagnosis, we did not make direct comparisons with earlier estimates2 owing to the 2015 transition from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and because earlier studies may not have limited the sample to in-hospital births.
Role of C-Reactive Protein for Late-Onset Neonatal Sepsis
Eleanor J. Molloy, MB, PhD; Tobias Strunk, MD, PhD
doi : 10.1001/jamapediatrics.2020.2126
JAMA Pediatr. 2021;175(1):100-101
To the Editor In many neonatal units around the world, C-reactive protein (CRP) is standardly used as part of the diagnosis of neonatal sepsis, most commonly in combination with full blood cell count and clinical signs. Its negative predictive value is well established in clinical practice as part of antimicrobial stewardship to optimize antibiotic use. The meta-analysis of CRP in late-onset sepsis by Brown et al1 confirms that CRP cannot be used as a single marker of neonatal sepsis or magic bullet diagnostic test, and this is reflected in clinical practice. Currently, there is no ideal diagnostic test for sepsis, irrespective of patient age. Further, this article highlighted the continued use of a definition of neonatal sepsis based on microbiologically confirmed infection rather than sepsis. This is in clear contrast to the Sepsis-3 consensus2 definition in adults and children that instead uses the presence of organ dysfunction without requirement for microbiologic confirmation.2 This definition thus acknowledges the lack of a definitive sepsis biomarker and the significant limitations of traditional microbiologic culture, in neonates and preterm infants in particular, with typically small available blood volumes and (maternal) antibiotic exposure.
Role of C-Reactive Protein for Late-Onset Neonatal Sepsis
Brett Burstein, MDCM, PhD, MPH; Marc Beltempo, MD, MSc; Patricia S. Fontela, MD, PhD
doi : 10.1001/jamapediatrics.2020.2129
JAMA Pediatr. 2021;175(1):101-102
To the Editor Neonatal sepsis remains a common diagnostic challenge. The diagnostic criterion standard is a microbiologically confirmed infection often requiring 24 to 48 hours; clinicians seek biomarkers to aid in rapid and accurate diagnosis. The meta-analysis by Brown et al1 evaluated the test characteristics of C-reactive protein (CRP) for late-onset neonatal infection, addressing the use of a widely available, inexpensive biomarker increasingly used for the evaluation of sepsis among newborns in a variety of settings including intensive care units and emergency departments. The meta-analysis included 2225 infants from 22 globally diverse studies and reported median specificity of CRP of 0.74 and median sensitivity of 0.62. The authors concluded that CRP is unlikely to aid early diagnosis or select infants for antimicrobial treatment at initial evaluation. This study underscores that CRP should not be used to decide to withhold antibiotics in a newborn suspected of infection and that obtaining sufficient blood volume to optimize cultures should be prioritized over CRP testing.
Treating Migraine in Children and Adolescents
Amy A. Gelfand, MD, MAS; Peter J. Goadsby, MBBS
doi : 10.1001/jamapediatrics.2020.2002
JAMA Pediatr. 2021;175(1):102
To the Editor We read with interest the Editorial by Zernikow1 regarding the meta-analysis2 published in JAMA Pediatrics on pharmacologic migraine prevention in children and adolescents. As experts, we agree with Zernikow that “migraine is not just a headache”1 and thus struggle with the advice that the “…cornerstone of treatment… is pain education.”1 Rather, it is education based on the underlying problem, which is very rarely education just about pain. Moreover, we agree that “globally, migraine experts recommend the regular use of pharmacologic prophylactic treatment in childhood.”1 However, this is where our agreement ends.
Treating Migraine in Children and Adolescents—Reply
Boris Zernikow, PhD, MD
doi : 10.1001/jamapediatrics.2020.2011
JAMA Pediatr. 2021;175(1):103
In Reply I greatly appreciate the comments from Gelfand and Goadsby. For many years they have striven to lessen the pain of children with chronic headaches. Their letter in response to my Editorial1 on the excellent article from Locher et al2 provides me with the opportunity to differentiate my biopsycho-social perspective on migraine.
Maternal High-Dose Vitamin D Supplementation and Offspring Bone Mineralization Until Age 6 Years
Pengxiang Zhou, PharmM; Xiaomei Tong, MM
doi : 10.1001/jamapediatrics.2020.2008
JAMA Pediatr. 2021;175(1):103-104
To the Editor Brustad et al1 reported offspring 6-year bone health results from a randomized clinical trial of 623 women, who received 2800 IU/d vs 400 IU/d of vitamin D from pregnancy week 24 until 1 week after birth. However, we are concerned about the measurements, data integrity, and the generalizability of the results.
Maternal High-Dose Vitamin D Supplementation and Offspring Bone Mineralization Until Age 6 Years—Reply
Nicklas Brustad, MD; Hans Bisgaard, MD, DMSc; Bo L. Chawes, MD, PhD, DMSc
doi : 10.1001/jamapediatrics.2020.2017
JAMA Pediatr. 2021;175(1):104
In Reply Zhou and Tong express their concerns about “the measurements, data integrity, and the generalizability of the results” reported in our publication on bone mineralization in offspring of mothers receiving high-dose vitamin D compared with standard dose from gestational week 24 to 1 week post partum in a double-blind, randomized clinical trial.1
Potentials of Telerehabilitation for Families of Children With Special Health Care Needs During the Coronavirus Disease 2019 Emergency
Livio Provenzi, PhD; Renato Borgatti, MD, PhD
doi : 10.1001/jamapediatrics.2020.2351
JAMA Pediatr. 2021;175(1):105
To the Editor We recently read the article from Thompson and Rasmussen,1 and we appreciate the focus that JAMA Pediatrics is dedicating to the effects of the coronavirus disease 2019 (COVID-19)2 emergency on children with special health care needs and their families. We wholeheartedly agree with the authors about the urgent necessity of taking care of families of at-risk children by quickly acknowledging and adequately responding to this epidemic. Here, we would like to highlight that the necessary mitigation strategies adopted by many countries to limit the virus spread include the reduction or the complete closing of rehabilitation units and centers, with the consequent suspension of rehabilitation programs. As a consequence, fragile individuals with severe neurodevelopmental conditions, especially children and their parents, are exposed to the risk of being left alone and without supervised rehabilitation support.1
Potentials of Telerehabilitation for Families of Children With Special Health Care Needs During the Coronavirus Disease 2019 Emergency—Reply
Lindsay A. Thompson, MD, MS; Sonja A. Rasmussen, MD, MS
doi : 10.1001/jamapediatrics.2020.2357
JAMA Pediatr. 2021;175(1):105-106
In Reply We appreciate the comments from Provenzi and Borgatti, who offer perspectives on telerehabilitation solutions during the coronavirus disease 2019 (COVID-19) pandemic in response to our article.1 As our article noted that children with special health care needs might be more likely to have COVID-19–related complications, these pediatric neurologists who learned early from Italy’s difficult COVID-19 experience note how families of children who use specialized rehabilitation centers benefitted from telerehabilitation services to mitigate the “hopelessness” resulting from the necessary COVID-19 social isolation. As this pandemic unfolds, we agree that a specialized approach to tailor the delivery of pediatric care is needed. We encourage this kind of innovation for pediatric care because children and their families will require novel approaches to medical management and engagement.
Debates Around the Role of School Closures in the Coronavirus 2019 Pandemic
Shuliang Oliver Cheng, BSc; Aurelia Liu, MBChB
doi : 10.1001/jamapediatrics.2020.3601
JAMA Pediatr. 2021;175(1):106
To the Editor: We read with great interest the article by Esposito and Principi,1 who expressed skepticism as to whether school closure is an effective measure in mitigating the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was interesting to read that Taiwan successfully slowed the spread of SARS-CoV-2 without school closure. Additionally, they highlighted that school closure had no significant effect on the spread of SARS-CoV-2 in China. Other countries, such Japan, Israel, Denmark, and Norway, also closed their schools in an attempt to mitigate the spread of SARS-CoV-2. Interestingly, Denmark and Norway reopened their schools in April 2020 and have continued to see a decline in the number of new infections as of May 2020.2
Debates Around the Role of School Closures in the Coronavirus 2019 Pandemic
Sergio Verd, MD; Marta L?pez-Garc?a, MD
doi : 10.1001/jamapediatrics.2020.3604
JAMA Pediatr. 2021;175(1):106-107
To the Editor On March 18, 2020, coronavirus disease 2019 (COVID-19)–related school closures affected roughly 50% of children worldwide. The situation had rapidly escalated from 15% of countries with school closures the previous week.1 At the time of writing, the situation has changed yet again; over the last month, classes have resumed for most pupils in 22 European countries, and other countries are in the process of reopening educational centers to offer support to parents of children younger than 6 years or with special needs.
Debates Around the Role of School Closures in the Coronavirus 2019 Pandemic
Ping-I Lin, MD, PhD; Yi-Chia Chen, MD
doi : 10.1001/jamapediatrics.2020.3549
JAMA Pediatr. 2021;175(1):107
To the Editor We read with interest the article by Esposito and Principi.1 The authors have provided several arguments against the benefits of school closures, which have been enacted by more than 90% of the European countries during the coronavirus disease 2019 (COVID-19) pandemic. However, some of the points made by the authors appeared to be debatable.
Debates Around the Role of School Closures in the Coronavirus 2019 Pandemic—Reply
Susanna Esposito, MD; Nicola Principi, MD
doi : 10.1001/jamapediatrics.2020.3552
JAMA Pediatr. 2021;175(1):107-108
In Reply In the first weeks of the new coronavirus disease 2019 (COVID-19) pandemic, it was presumed that children could be, as previously shown for influenza, among the major causes of disease diffusion. This explains why to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), schools were closed in in most countries. However, we highlighted that this decision could be debated.1 Most of the studies used to support school closure, including those cited by Lin and Chen, could be criticized because they poorly considered the age-dependent effect in the transmission of SARS-CoV-2. Moreover, the effect of school closure was not adequately evaluated. Only supposed medical advantages were analyzed without considering that potential benefits could have been canceled by the onset of social, economic, and health inequities that follow school closure.
