♦ Riley AR, et al. Acad Pediatr, Nov. 15, 2016,
More than three-quarters of parents reported using
time-outs to manage their child’s misbehavior, but the
vast majority made at least one implementation error,
according to a survey of 401 parents of children ages
15 months to 10 years.
Time-out is based on removing positive reinforcement
such as social attention and access to physical objects. Evidence shows it is effective in reducing behaviors such as
aggression and noncompliance. It also is the most widely
used disciplinary method among parents and is commonly recommended by primary care providers.
The authors of this study, however, noted that many
parents report the procedure does not work. Therefore,
they set out to determine how parents use time-outs.
Parents who visited a primary care clinic were recruited to complete a survey that asked about their
discipline practices, how difficult it was to manage
their child’s behavior, perception of time-out and how
they implemented the procedure.
About 77% had used time-out, and 70% said it
usually or always was effective. However, 85% reported using at least one technique that was counter
to evidence-based practices, and 64% made multiple
implementation errors. The most common mistakes
were giving the child multiple warnings before putting
him or her in time-out, talking to the child during
time-out, and allowing the child access to toys, books,
electronics or other people.
Parents who said time-out was effective were more
likely to use the method correctly.
The authors said clinicians should advise parents to
give one warning then a short reason for the time-out
(e.g. “no hitting”). Parents should not talk to their
child during the time-out, and they should reduce the
child’s access to stimulation. If a child tries to escape,
the parent should return him or her to the time-out
area with minimal interaction.
“Ultimately, counseling on TO (time-out) may be
misguided or ineffective for many families until more
positive parenting practices are established,” the au-
by Carla Kemp • Senior Editor
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in children a growing
♦ Logan LK, et al. J Pediatric Infect Dis
Soc, Nov. 16, 2016, http://bit.ly/2i64
The prevalence of multidrug-resistant
(MDR) and carbapenem-resistant (CR)
Pseudomonas aeruginosa infections in children increased significantly from 1999 to
2012, according to data from a national
P. aeruginosa is responsible for about
51,000 health care-associated infections in
adults and children each year, according to
the Centers for Disease Control and Prevention. More than 6,000 of the infections
(13%) are MDR and account for 400 deaths.
Most studies have focused on P. aeruginosa
infections in patients with cystic fibrosis, and
none have looked at MDR or CR P. aeruginosa infections in children. Therefore, the
authors of this study assessed the epidemiology of P. aeruginosa isolates from children
without cystic fibrosis and analyzed trends
in antibiotic resistance.
Researchers used antibiotic-susceptibil-ity data from about 300 inpatient, outpatient and long-term care facilities to identify MDR and CR P. aeruginosa isolates in
77,349 patients ages 1-17 years.
Results showed 20.2% were MDR, 11.3%
were CR and 8.4% were MDR and CR.
From 1999 to 2012, MDR isolates in-
creased from 15.4% to 26%, while CR iso-
lates rose from 9.4% to 20%.
After adjusting for year, patient and isolate
characteristics, the prevalence of MDR and
CR P. aeruginosa was highest among children ages 13-17 years, in the West North
Central region of the U.S. and in respiratory
The prevalence of CR P. aeruginosa was
highest among patients in intensive care
units, while MDR prevalence was highest
among children in long-term care facilities.
The increase in MDR P. aeruginosa strains
could be due to increases in prescriptions for
third- and fourth-generation cephalosporins
and other broad-spectrum agents in outpatient settings, according to the authors.
“The results of our study highlight the
need for bacterial surveillance, strategies for
implementing effective infection-preven-tion, and antimicrobial stewardship programs,” they concluded.
Many parents use time-outs incorrectly
Pertussis among infants younger than 1 year of age remains high
♦ Masseria C, et al. Pediatr Infect Dis J, Nov. 28,
The pertussis rate among infants younger than 12
months of age is high, and the incidence is highest
among 3-month-olds, according to a nationwide
study of 1.2 million infants.
Pertussis is the least-controlled bacterial disease for
which a vaccine is universally recommended, according to the Centers for Disease Control and Prevention.
However, limited data are available on the disease burden in U.S. infants.
Using databases of commercial health plans around
the country, researchers estimated the incidence of
pertussis in infants younger than 1 year of age who
were born between July 2005 and September 2010.
They also sought to identify factors associated with
a pertussis diagnosis by comparing each infant diagnosed with pertussis with 10 matched infants without
Results showed 1,023 infants were diagnosed with
pertussis during the study period. In the two weeks
before their diagnosis, infants were 18 times more
likely than their matches to have been treated for a
cough, seven times more likely to have a wheezing-re-
lated illness and nearly six times more likely to have
an acute upper respiratory infection.
The difference in health care costs between the two
groups was highest among 1- and 2-month-olds at
$18,781 and $15,446, respectively.
About half of both groups had received at least one
dose of diphtheria, tetanus and acellular pertussis vac-
cine prior to the date of the pertussis diagnosis in the
“This study supports the CDC decision to protect
infants from exposure to the pertussis organism by recommending a dose of reduced-antigen Tdap vaccine
to each pregnant woman between 27 and 36 weeks
gestation during each pregnancy and to all people
with close contact with the infants, including parents,
grandparents, relatives, babysitters, nannies, daycare
providers, and housekeepers,” the authors wrote.
Clinicians should advise parents not to talk to their
child during a time-out, and they should reduce the
child’s access to stimulation, according to the authors
of a recent study.