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In This Issue of JAMA Pediatrics |

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JAMA Pediatr. 2016;170(1):3. doi:10.1001/jamapediatrics.2015.2494.
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Healthy gut microbiota may reduce intestinal permeability and potentially prevent the development of type 1 diabetes mellitus. Uusitalo and colleagues examine the association between early probiotic exposure and islet autoimmunity among high-risk children in The Environmental Determinants of Diabetes in the Young Study. Administration of probiotics during the first 27 days of life was associated with a lower risk for islet autoimmunity, primarily among children with the highest HLA genotype. Weinstock’s editorial examines the role of the bacteria in probiotics and discusses the potential for this type of research.

Sleep disturbance is common in children with atopic dermatitis but effective clinical management for this problem is lacking. The randomized clinical trial conducted by Chang and colleagues uses a crossover design to study the effects of 3 mg of melatonin at night on sleep and disease severity. Sleep-onset latency was shortened by 21.4 minutes and disease symptoms improved with melatonin treatment. Melatonin was a safe and effective way to improve both sleep and skin condition in children with atopic dermatitis.

With changes in the insurance marketplace and uncertainty about the future of children’s health insurance coverage, it is important to examine the quality of current coverage and its effects on access to care. Kreider and colleagues use data from the National Survey of Children’s Health to examine 4 insurance types: Medicaid, the Children’s Health Insurance Program, private insurance, and uninsured for children in low to moderate income households. Children with all types of insurance had challenges in accessing specialty care, and families with private insurance were much more likely to experience out-of-pocket costs than were those in which children were insured by Medicaid or the Children’s Health Insurance Program. Keller’s editorial discusses the special needs of children in a health insurance system primarily designed for adults.

It is unknown how often skeletally immature children with radiograph-negative lateral ankle injuries have a Salter-Harris type I fracture of the distal fibula. Boutis and colleagues study 135 children suspected of having such fractures with magnetic resonance imaging within 1 week of injury. Only 3% had Salter-Harris type I distal fibula fractures, 80% had ligament injuries, and all children got better when treated with a removable ankle brace and activities as tolerated. The accompanying editorial by Gill and Klassen discusses how the current practice of immobilization of these injuries is not necessary and that this study should change clinical management.




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