Publications by authors named "Randall Sterkel"

18 Publications

  • Page 1 of 1

Ready for the Challenge of Depression Care in the Medical Home.

Clin Pediatr (Phila) 2019 06 13;58(7):816-818. Epub 2019 Mar 13.

1 Washington University, St. Louis, MO, USA.

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http://dx.doi.org/10.1177/0009922819834280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944060PMC
June 2019

Opioids in Adolescents' Homes: Prevalence, Caregiver Attitudes, and Risk Reduction Opportunities.

Acad Pediatr 2019 Jan - Feb;19(1):103-108. Epub 2018 Jul 6.

Department of Pediatrics (JM Garbutt, K Kulka, S Dodd, and R Sterkel, and K Plax).

Objective: The most common source of misused opioids is pain relievers prescribed for family and friends. This study was conducted to assess knowledge, attitudes, and behaviors of adolescents' caregivers regarding prescribed opioids in the home.

Methods: The self-administered survey was completed by caregivers in the waiting rooms of 12 pediatric practices in the Midwest. Eligibility required living in a home where youth age ≥10 years were frequently present. Out of 793 eligible caregivers, 700 (88.3%) completed the survey, 76.8% of whom were the parent.

Results: Among the 700 caregiver respondents, 34.6% reported opioids in the home (13.6% active prescriptions, 12.7% leftover medications, 8.3% both). Of those with an active prescription, 66.0% intended to keep any leftover medications for future needs (for the patient, 60.1%; for someone else, 5.9%). Of those with leftover medications, 60.5% retained them for the same reason (for the patient, 51.0%; for someone else, 9.5%). Others kept medications unintentionally, either because they never got around to disposing of them (30.6%), they did not know how to dispose of them properly (15.7%), or it never occurred to them to dispose of the medications (7.5%). Many caregivers were unaware that adolescents commonly misuse opioids (30.0%) and use them to attempt suicide (52.3%), and that opioid use can lead to heroin addiction (38.6%). According to the surveys, 7.1% would give leftover opioid medications to an adolescent to manage pain and 5.9% might do so.

Conclusions: Opioids are prevalent in homes in our community, and many parents are unaware of the risks they pose. Study findings can inform strategies to educate parents about opioid risk and encourage and facilitate timely, safe disposal of unused medications.
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http://dx.doi.org/10.1016/j.acap.2018.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914255PMC
February 2020

What Are Parents Willing to Discuss with Their Pediatrician About Firearm Safety? A Parental Survey.

J Pediatr 2016 12 14;179:166-171. Epub 2016 Sep 14.

Department of Pediatrics, Washington University St Louis, St. Louis, MO.

Objective: To determine if parents are receptive to discussing firearm safety with their pediatrician.

Study Design: Parents completed a self-administered paper survey during a pediatric office visit. Responses of those who confirmed and denied household firearms were compared using Fisher exact test.

Results: Between March 23 and May 21, 2015, 1246 of 1363 eligible parents (91.4%) completed the survey (22.6% African American, 79.5% at least some college education); 36% of respondents reported household firearms (owners). An additional 14.3% reported that their child was often in homes that contained firearms. Of the 447 owners, 25.1% reported ≥1 firearm was stored loaded, and 17.9% carried a firearm when leaving the house. Seventy-five percent of parents thought the pediatrician should advise about safe storage of firearms (owners 71.1%, others 77.5%), 16.9% disagreed (owners 21.9%, others 13.4%), and 8.2% were uncertain. Sixty-six percent thought pediatricians should ask about the presence of household firearms (owners 58.4%, others 70.9%), 23.2% disagreed (owners 31.5%, others 17.8%), and 10.5% were uncertain. Differences in parental opinions between owners and other parents were statistically significant. Twenty-two percent of owners would ignore advice to not have household firearms for safety reasons, and 13.9% would be offended by such advice. Only 12.8% of all parents reported a discussion about firearms with the pediatrician.

Conclusions: Avoiding direct questioning about firearm ownership and extending the discussion about why and how to ensure safe storage of firearms to all parents may be an effective strategy to decrease firearm-related injuries and fatalities in children.
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http://dx.doi.org/10.1016/j.jpeds.2016.08.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123916PMC
December 2016

Parental Use of Electronic Cigarettes.

Acad Pediatr 2015 Nov-Dec;15(6):599-604. Epub 2015 Aug 22.

Department of Pediatrics, Washington University, St Louis, Mo.

Objective: To describe parental use of electronic cigarettes (e-cigs) to better understand the safety risks posed to children.

Methods: Between June 24 and November 6, 2014, parents completed a self-administered paper survey during an office visit to 15 pediatric practices in a Midwestern practice-based research network. Attitudes towards and use of e-cigs are reported for those aware of e-cigs before the survey.

Results: Ninety-five percent (628 of 658) of respondents were aware of e-cigs. Of these, 21.0% (130 of 622) had tried e-cigs at least once, and 12.3% (77) reported e-cig use by ≥1 person in their household (4.0% exclusive e-cig use, 8.3% dual use with regular cigarettes). An additional 17.3% (109) reported regular cigarette use. Most respondents from e-cig-using homes did not think e-cigs were addictive (36.9% minimally or not addictive, 25.0% did not know). While 73.7% believed that e-liquid was very dangerous for children if they ingested it, only 31.2% believed skin contact to be very dangerous. In 36.1% of e-cig-using homes, neither childproof caps nor locks were used to prevent children's access to e-liquid. Only 15.3% reported their child's pediatrician was aware of e-cig use in the home.

Conclusions: E-cig use occurred in 1 in 8 homes, often concurrently with regular cigarettes. Many parents who used e-cigs were unaware of the potential health and safety hazards, including nicotine poisoning for children, and many did not store e-liquid safely. Pediatricians could provide education about e-cig associated safety hazards but are unaware of e-cig use in their patients' homes.
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http://dx.doi.org/10.1016/j.acap.2015.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639418PMC
December 2016

Opportunities to reduce children's excessive consumption of calories from beverages.

Clin Pediatr (Phila) 2014 Oct 2;53(11):1047-54. Epub 2014 Jul 2.

Washington University in St Louis, St Louis, MO, USA

Objective: To describe children's consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice (FJ), and identify factors that may reduce excessive consumption.

Design: A total of 830 parents of young children completed a 36-item questionnaire at the pediatricians' office.

Results: Children consumed soda (62.2%), other SSBs (61.6%), and FJ (88.2%): 26.9% exceeded the American Academy of Pediatrics' recommended daily FJ intake. 157 (18.9%) children consumed excessive calories (>200 kcal/d) from beverages (median = 292.2 kcal/d, range 203.8-2177.0 kcal/d). Risk factors for excessive calorie consumption from beverages were exceeding recommendations for FJ (odds ratio [OR] = 119.7, 95% confidence interval [CI] = 52.2-274.7), being 7 to 12 years old (OR = 4.3, 95%CI = 1.9-9.9), and having Medicaid insurance (OR = 2.6, 95%CI = 1.1-6.0). Parents would likely reduce beverage consumption if recommended by the physician (65.6%).

Conclusions: About 1 in 5 children consumes excessive calories from soda, other SSBs and FJ, with FJ the major contributor.
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http://dx.doi.org/10.1177/0009922814540989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157093PMC
October 2014

Using parental perceptions of childhood allergic rhinitis to inform primary care management.

Clin Pediatr (Phila) 2014 Jul 6;53(8):758-63. Epub 2014 May 6.

Washington University in St Louis, St Louis, MO, USA.

Objective: To describe parents' experience with their child's allergic rhinitis (AR) to inform management by the primary care provider (PCP).

Study Design: Two hundred parents with a child 7 to 15 years old with AR symptoms within the past 12 months completed a paper survey.

Results: The child's AR was identified as a significant problem in spring (89.3%), fall (63.4%), summer (50.3%), and winter (21.4%); 51.3% had persistent disease. AR symptoms most commonly interfered with the child's outdoor activities and sleeping, and frequently bothered the parent and other family members. Most parents (88.3%) wanted to know what their child was allergic to and had many concerns about treatment options. A total of 62.9% had sought AR care from the PCP in the past 12 months.

Conclusions: Many families experience significant morbidity from their child's AR and turn to their PCP for help. We identified opportunities for the PCP to reduce AR morbidity.
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http://dx.doi.org/10.1177/0009922814533590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222999PMC
July 2014

The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial.

Clin Pediatr (Phila) 2013 Nov 3;52(11):1014-21. Epub 2013 Oct 3.

1Washington University in St. Louis, St. Louis, MO, USA.

Background. Although common practice, evidence to support treatment of croup with prednisolone is scant. Methods. We conducted a community-based randomized trial to compare the effectiveness of prednisolone (2 mg/kg/d for 3 days, n = 41) versus 1 dose of dexamethasone (0.6 mg/kg) and 2 doses of placebo (n = 46). Participants were children 1 to 8 years old with croup symptoms ≤48 hours, categorized as mild (42%) or moderate (58%). Results. There were no differences for those treated with dexamethasone or prednisolone for additional health care for croup (2% vs 7%, P = .34), duration of croup symptoms (2.8 vs 2.2 days, P = .63), nonbarky cough (6.1 vs 5.9 days, P = .81), nights with disturbed sleep for the parent (0.68 vs 1.21 nights, P = .55), and days with stress (1.39 vs 1.56 days, P = .51). Conclusion. There were no detected differences in outcomes between the 2 croup treatments for either child or parent.
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http://dx.doi.org/10.1177/0009922813504823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019394PMC
November 2013

A telephone coaching intervention to improve asthma self-management behaviors.

Pediatr Nurs 2013 May-Jun;39(3):125-30, 145

St. Louis Children's Hospital Answer Line, St. Louis Children's Hospital, St. Louis, MO, USA.

Long recognizing that asthma, one of the most common chronic childhood diseases, is difficult to manage, the National Asthma Education Prevention Program developed clinical practice guidelines to assist health care providers, particularly those in the primary care setting. Yet, maintenance asthma care still fails to meet national standards. Therefore, in an attempt to improve and support asthma self-management behaviors for parents of children 5 to 12 years of age with persistent asthma, a novel nurse telephone coaching intervention was tested in a randomized, controlled trial. A detailed description of the intervention is provided along with parent satisfaction results, an overview of the training used to prepare the nurses, and a discussion of the challenges experienced and lessons learned.
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August 2013

Parents' experiences with pediatric care at retail clinics.

JAMA Pediatr 2013 Sep;167(9):845-50

Importance: Little is known about the use of retail clinics (RCs) for pediatric care.

Objective: To describe the rationale and experiences of families with a pediatrician who also use RCs for pediatric care.

Design And Setting: Cross-sectional study with 19 pediatric practices in a Midwestern practice-based research network.

Participants: Parents attending the pediatrician’s office.

Main Outcomes And Measures: Parents’ experience with RC care for their children.

Results: In total, 1484 parents (91.9% response rate) completed the self-administered paper survey. Parents (23.2%) who used the RC for pediatric care were more likely to report RC care for themselves (odds ratio, 7.79; 95% CI, 5.13-11.84), have more than 1 child (2.16; 1.55-3.02), and be older (1.05; 1.03-1.08). Seventy-four percent first considered going to the pediatrician but reported choosing the RC because the RC had more convenient hours (36.6%), no office appointment was available (25.2%), they did not want to bother the pediatrician after hours (15.4%), or they thought the problem was not serious enough (13.0%). Forty-seven percent of RC visits occurred between 8 am and 4 pm on weekdays or 8 am and noon on the weekend. Most commonly, visits were reportedly for acute upper respiratory tract illnesses (sore throat, 34.3%; ear infection, 26.2%; and colds or flu, 19.2%) and for physicals (13.1%). While 7.3% recalled the RC indicating it would inform the pediatrician of the visit, only 41.8% informed the pediatrician themselves.

Conclusions And Relevance: Parents with established relationships with a pediatrician most often took their children to RCs for care because access was convenient. Almost half the visits occurred when the pediatricians’ offices were likely open.
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http://dx.doi.org/10.1001/jamapediatrics.2013.352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019395PMC
September 2013

Pediatric providers' attitudes toward retail clinics.

J Pediatr 2013 Nov 28;163(5):1384-8.e1-6. Epub 2013 Jun 28.

Washington University in St Louis, St Louis, MO. Electronic address:

Objective: To describe pediatric primary care providers' attitudes toward retail clinics and their experiences of retail clinics use by their patients.

Study Design: A 51-item, self-administered survey from 4 pediatric practice-based research networks from the midwestern US, which gauged providers' attitudes toward and perceptions of their patients' interactions with retail clinics, and changes to office practice to better compete.

Results: A total of 226 providers participated (50% response). Providers believed that retail clinics were a business threat (80%) and disrupted continuity of chronic disease management (54%). Few (20%) agreed that retail clinics provided care within recommended clinical guidelines. Most (91%) reported that they provided additional care after a retail clinic visit (median 1-2 times per week), and 37% felt this resulted from suboptimal care at retail clinics "most or all of the time." Few (15%) reported being notified by the retail clinic within 24 hours of a patient visit. Those reporting prompt communication were less likely to report suboptimal retail clinic care (OR 0.20, 95% CI 0.10-0.42) or disruption in continuity of care (OR 0.32, 95% CI 0.15-0.71). Thirty-six percent reported changes to office practice to compete with retail clinics (most commonly adjusting or extending office hours), and change was more likely if retail clinics were perceived as a threat (OR 3.70, 95% CI 1.56-8.76); 30% planned to make changes in the near future.

Conclusions: Based on the perceived business threat, pediatric providers are making changes to their practice to compete with retail clinics. Improved communication between the clinic and providers may improve collaboration.
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http://dx.doi.org/10.1016/j.jpeds.2013.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812257PMC
November 2013

What are parents worried about? Health problems and health concerns for children.

Clin Pediatr (Phila) 2012 Sep 26;51(9):840-7. Epub 2012 Jul 26.

Washington University, St Louis, MO 63110, USA.

Unlabelled: Patient-centered care requires pediatricians to address parents' health concerns, but their willingness to solicit parental concerns may be limited by uncertainty about which topics will be raised. The authors conducted surveys of parents to identify current health-related issues of concern.

Methods: Participants rated 30 items as health problems for children in their community (large, medium, small, or no problem) and volunteered concerns for their own children.

Results: A total of 1119 parents completed the survey. Allergies (69%), lack of exercise (68%), asthma (65%), attention deficit hyperactivity disorder (65%), Internet safety (63%), obesity (59%), smoking (58%), and bullying (57%) were identified as important problems (large or medium) with variation among demographic subgroups. Concerns for their own children included healthy nutrition; obesity; lack of exercise, healthy growth and development; safety and injury prevention; and mental health issues.

Conclusion: Parents' health concerns for children are varied and may differ from those routinely addressed during well-child care.
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http://dx.doi.org/10.1177/0009922812455093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608110PMC
September 2012

Providing depression care in the medical home: what can we learn from attention-deficit/ hyperactivity disorder?

Arch Pediatr Adolesc Med 2012 Jul;166(7):672-3

Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8116, St Louis, MO 63110, USA.

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http://dx.doi.org/10.1001/archpediatrics.2011.1565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607309PMC
July 2012

Telephone coaching for parents of children with asthma: impact and lessons learned.

Arch Pediatr Adolesc Med 2010 Jul;164(7):625-30

Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA.

Objective: To determine whether an asthma coaching program can improve parent and child asthma-related quality of life (QOL) and reduce urgent care events.

Design: Randomized controlled trial of usual care vs usual care with coaching. Comparisons were made between groups using mixed models.

Setting: A Midwest city.

Participants: A community-based sample of 362 families with a child aged 5 to 12 years with persistent asthma.

Intervention: A 12-month structured telephone coaching program in which trained coaches provided education and support to parents for 4 key asthma management behaviors.

Main Outcome Measures: Parental and child QOL measured with a validated, interview-administered, 7-point instrument and urgent care events in a year (unscheduled office visits, after-hours calls, emergency department visits, or hospitalizations) determined by record audit.

Results: Parental asthma-related QOL scores improved by an average of 0.67 units (95% confidence interval [CI], 0.49 to 0.84) in the intervention group and 0.28 units (95% CI, 0.10 to 0.46) in the control group. The difference between study groups was statistically significant (difference, 0.38; 95% CI, 0.14 to 0.63). No between-group difference was found in the change in the child's QOL (difference, -0.17; 95% CI, -0.47 to 0.12) or in the mean number of urgent care events per year (difference, 1.15; 95% CI, 0.82 to 1.61). The proportion of children with very poorly controlled asthma in the intervention group decreased compared with the control group (difference, 0.34; 95% CI, 0.21 to 0.48).

Conclusions: A telephone coaching program can improve parental QOL and can be implemented without additional physician training or practice redesign.
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http://dx.doi.org/10.1001/archpediatrics.2010.91DOI Listing
July 2010

Physician and parent response to the FDA advisory about use of over-the-counter cough and cold medications.

Acad Pediatr 2010 Jan-Feb;10(1):64-9. Epub 2009 Oct 12.

Department of Pediatrics, Washington University in St. Louis, Missouri 63110, USA.

Objective: The aim of this study was to assess the likely impact of the US Food and Drug Administration (FDA) advisory not to use over-the-counter (OTC) cough and cold products for children aged <2 years on care provided by pediatricians and parents.

Methods: A mailed survey was completed by 105 community pediatricians (53% response rate), and 1265 parents with children aged <12 years completed a self-administered survey while waiting for an office visit.

Results: All physicians were aware of the advisory; 75% agreed with it. Fifty-nine percent did not recommend OTC cough and cold products for children aged <2 years before the advisory, and 35% were less likely to do so afterward. Seventy-three percent of parents were aware of the advisory, 70% believed these products relieved symptoms, 68% did not believe they were dangerous, and 74% had them at home. After the advisory, 21% of parents were more likely to request an antibiotic from the doctor. Among the parents, 225 only had children aged <2 years and 695 only had children aged 2 to 11 years; of these parental groups, 53% and 10% of parents, respectively, did not use these products before the advisory, an additional 33% and 28%, respectively, were less likely to do so afterward, and 15% and 61%, respectively, would continue use them.

Conclusions: Pediatricians must be prepared for requests from parents for antibiotics and other remedies for symptom relief for their children with colds. As no effective alternatives are available, maybe nontreatment should be promoted.
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http://dx.doi.org/10.1016/j.acap.2009.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433755PMC
April 2010

Socioeconomic, family, and pediatric practice factors that affect level of asthma control.

Pediatrics 2009 Mar;123(3):829-35

St Louis Children's Hospital, Washington University School of Medicine, Department of Pediatrics, Division of Allergy and Pulmonary Medicine, One Children's Place, St Louis, MO 63110, USA.

Background: Multiple issues play a role in the effective control of childhood asthma.

Objective: To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians.

Patients And Methods: Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications.

Results: Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control.

Conclusions: Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.
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http://dx.doi.org/10.1542/peds.2008-0504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723164PMC
March 2009

What constitutes maintenance asthma care? The pediatrician's perspective.

Ambul Pediatr 2007 Jul-Aug;7(4):308-12

Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.

Objective: To describe how pediatricians report they provide maintenance care for children with persistent asthma, and to identify opportunities for improvement.

Methods: An anonymous 34-item survey was completed by community pediatricians in St Louis, Missouri, between June 2005 and October 2005. Physicians reported the percentage of patients for whom they would prescribe inhaled corticosteroids, and selected from checklists the activities and questions they would use during a maintenance care visit.

Results: A total of 135 (60%) of 225 eligible pediatricians responded. Respondents reported they prescribed inhaled corticosteroids for most patients (median 80% patients, range, 10%-100%). Although most respondents used specific questions to assess recent asthma burden including inquiring about the frequency of daytime (86%) and nighttime (83%) symptoms, fewer asked about activity limitations such as school absences (58%). Some reported using specific questions to assess medication adherence such as how often doses were missed (49%), or included collaborative activities to support daily self-management such as setting asthma care goals (60%), but fewer asked how symptoms were monitored (44%) or assessed the effect of the child's asthma on the parent and family (24%).

Conclusions: Findings from this self-reported physician survey suggest that asthma management practices fall short of optimal standards. Opportunities for improvement include more comprehensive and detailed assessment of asthma control and medication adherence, collaborative goal setting, and better collaboration with the parent to support effective self-management. Further interventions to reduce asthma morbidity need to support physicians with these activities.
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http://dx.doi.org/10.1016/j.ambp.2007.03.007DOI Listing
February 2008

Payment for telephone care: from policy to practice.

Pediatrics 2007 Mar;119(3):654-5; author reply 655

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http://dx.doi.org/10.1542/peds.2006-3267DOI Listing
March 2007