New research was presented at the 2022 American Academy of Pediatrics National Conference & Exhibition from October 7-11. The features below highlight some of the studies presented during the conference.

COVID-19-Related Sports Cancellations Heighten Anxiety & Depression in Adolescents

The cancellation of sports early in the COVID-19 pandemic was accompanied by reductions in physical activity and QOL among adolescents, as well as significantly increased rates of anxiety and depression. To examine the effect that returning to sports had on these domains, Drew Watson, MD, MS, and colleagues examined surveys completed by 17,421 teenagers in May 2020 and May 2021. Following the cancellations, adolescent athletes reported decreased physical activity, poor QOL, and greater rates of anxiety and depression. One year later, athletes who were able to return to sports described significant improvements in physical activity and quality of life, and the proportion of adolescents who reported moderate to severe anxiety or depression decreased by approximately half. “Although the return to sports has been associated with large improvements in physical activity levels, [QOL], and mental health, we are still seeing higher levels of anxiety and depression than before COVID-19, suggesting that this will remain a vitally important priority for years to come,” Dr. Watson said in a statement.

BMI Increased Among Pediatric Patients During COVID-19 Pandemic

A study that examined BMI 2 years before the start of the COVID-19 pandemic and 1 year after the pandemic began found a significant increase in BMI during that period. The study, which was conducted among a pediatric population with primarily Medicaid insurance from one city in the United States, examined data from 238 patients, most of whom were Black (average age: 9.47 and 9.57 for females and males, respectively). Fast food, time spent using electronic devices, and physical activity were some of the factors that could impact BMI included in the study questionnaire. John Harrington, MD, and colleagues identified a significant correlation between increasing pediatric BMI and greater time spent with family and on screens. They also reported an 11% mean increase in BMI among the female cohort; the increase was not significant for the male cohort. “This study reinforces that the health of all communities was negatively impacted by the pandemic, especially lower income and predominantly [Black] communities,” Dr. Harrington said in a statement.

Conflicting information about the severity of pediatric COVID-19 outcomes confounds the medical community’s understanding of the impact of COVID-19 vaccination in this patient population. To address this, Robert Turer, MD, and colleagues examined clinical, demographic, and vaccination EHR data on a national level for children who tested positive for COVID-19 between March 12, 2020, and January 20, 2022. Among the 18.7% of patients in the entire sample who tested positive for COVID-19, 4.0% were hospitalized, required ICU care or ventilation, or died. The greatest predictors of severe outcomes in all groups “by far” were pediatric comorbidity index scores, which represented pre-COVID-19 comorbidities, and residency in the Southern US region. Among all groups, unknown insurance status, the alpha variant, and Black race were statistically significant and borderline clinically significant predictors of severe outcomes (P<0.0001). The OR for severe disease comparing at least one vaccination to no known vaccination was 0.55 in the vaccine-eligible cohort. “Our study found that the national disease burden of COVID-19 in children is unequally distributed, with worse outcomes in children with pre-existing illnesses and along racial and geographic lines,” a coauthor said in a statement. “Given the variance in child vaccination rates in the United States, we hope our research can inform outreach and other efforts to increase vaccination rates in children and adolescents, particularly in vulnerable regions and populations.”

Uptick in Biking-Related Fractures Mainly Seen in Pre-Teen & Teenage Boys

The lack of information about the national burden of fractures associated with biking among children prompted J. Todd Lawrence, MD, PhD, and colleagues to examine the National Electronic Injury Surveillance System for pediatric patients who presented to US EDs for fractures between 2001 and 2020. They identified 34,722 fractures, representing an estimated 1,019,509 fractures from 2001-2020 or 50,975 fractures annually. The overall trend was significant for a reduced rate of fractures over time (P<0.001). Most fractures occurred in patients who were male (71.8%), White (53.0%), and aged 10-12 (30.6%) or 13-15 (24.8%). Fractures were most common in the lower arm (25.2%), wrist (21.2%), or shoulder (10.5%). Only a small minority of patients with skull fractures were wearing helmets (14.2%). Following a steady decline for many years, the recent increase in fractures aligns with an uptick in other injuries associated with the COVID-19 pandemic. “The results of our study suggest that continued efforts teaching road safety and promoting helmet use should be targeted towards all children, but with additional efforts being directed towards the most affected population, namely 10- to 15-yearold boys,” Dr. Lawrence said in a statement.

Disparities Have ‘Profound Importance’ in Pediatric Asthma Management

A pilot program that evaluated the development of an Asthma Health Equity Index identified disparities based on race/ethnicity and language, among other factors, in children with moderate to severe asthma. Keri L. Carstairs, MD, and colleagues assessed the index through telephone conversations with families of children with poorly controlled asthma who were recently seen in the ED, using social determinants of health screenings to identify disparities. Race/ethnicity was associated with food insecurity (P<0.001), unstable housing (P<0.001), and tobacco use (P<0.001); language was associated with food insecurity (P<0.001), unstable housing (P<0.001), and transportation issues (P=0.05). Compared with Non-Hispanic (NH) White patients, individuals who were Hispanic, NH Black, and NH Other were three to five times more likely to experience unstable housing (P<0.001). Hispanic patients were three times more likely to experience food insecurity (P<0.001) and transportation issues (P<0.001), and NH Black patients were two times more likely to experience tobacco use/smoke exposure (P<0.001). Compared with English-speaking patients, Spanish-speaking patients were almost five times more likely to experience food insecurity (P<0.001) and two times more likely to experience unstable housing (P<0.001) and transportation issues (P=0.03). “When managing the health of a child and, in particular, any chronic condition such as asthma, it is critical to acknowledge the profound importance that social determinants, race, ethnicity, and language barriers play in the life of that child and family,” Dr. Carstairs said in a statement.