Importance:Adolescents are increasingly using generative artificial intelligence (AI) as an anonymous emotional support system, yet the association between affective use and mental health remains poorly understood. Objective:To examine the association between affective generative AI use and emotional problems among a large, diverse sample of youth. Design, Setting, and Participants:This cross-sectional study evaluates Ontario Health and Peer Relations Study data (May 2025 through March 2026) among students in grades 4 through 12 across 4 school boards in Ontario, Canada. Data were analyzed in May 2026. Exposures:Affective AI use (emotional support or advice) and functional AI use (school-related tasks). Main Outcomes and Measures:Emotional problems were assessed via the Ontario Child Health Study Emotional Behavioral Scales using a validated clinical threshold. Covariates included mattering, loneliness, and demographic characteristics. Results:The final analytic sample consisted of 39 761 students (mean [SD] age, 12.8 [2.4] years; 19 291 [48.5%] girls). A total of 8408 participants (21.1%) reported using AI for affective purposes. Female students, gender-diverse students, and students who were Black, Indigenous, or of other racial and ethnic groups besides White were more likely to have used AI for affective purposes compared with boys and White students, respectively. Additionally, students who were older and students who reported using AI for school reported incrementally higher affective AI use. In unadjusted models, affective AI use was associated with significantly higher emotional problem scores (mean [SD] score, 1.04 [0.54] with use vs 0.67 [0.51] without use; B = 0.37 [95% CI, 0.36 to 0.39]) and were twice as likely to have clinical emotional problems (57.7% vs 29.2%; prevalence ratio, 1.98 [95% CI, 1.91 to 2.04]). In fully adjusted models, affective AI use remained associated with emotional problems (B = 0.14 [95% CI, 0.13 to 0.15]), whereas functional AI use showed a modest dose-response association with emotional problems (ranging from B = 0.01 [95% CI, 0.00 to 0.02] with rare use to B = 0.04 [95% CI, 0.02 to 0.05] with a lot of use). A significant interaction between affective AI use and gender identity was observed, which was attenuated for gender-diverse students compared with boys (B = -0.07 [95% CI, -0.12 to -0.03]) and girls (B = -0.08 [95% CI, -0.13 to -0.03]). No significant interaction was observed between affective AI use and school level. Conclusions and Relevance:This cross-sectional study suggests that seeking emotional support from generative AI is a unique marker of psychological distress in children and adolescents, independent of mattering or loneliness. Clinical frameworks and digital literacy programs should distinguish between functional AI assistance and the use of algorithmic interfaces as a digital refuge for emotional needs.
Importance:In February 2025, Australia introduced maternal vaccination with bivalent respiratory syncytial virus prefusion F protein-based vaccine (RSVpreF) in the National Immunization Program for pregnant individuals from 28 weeks' gestation as the primary, year-round strategy to prevent RSV disease in infants 6 months of age or younger. Objective:To estimate effectiveness of RSVpreF vaccination during pregnancy against infant RSV hospitalization in Australia. Design, Setting, and Participants:This retrospective case-control study with a test-negative design was conducted in 9 hospitals across Australia with year-round respiratory testing for acute respiratory illness (ARI) among infants born from 28 weeks' gestation and hospitalized with ARI at 6 months of age or younger, March 1, 2025, through February 28, 2026. Data were analyzed March 2026 through May 2026. Exposure:Maternal RSVpreF vaccination administered from 28 weeks' gestation and 14 days or more before delivery. Main Outcomes and Measures:Maternal RSVpreF effectiveness was evaluated against hospitalization for RSV lower respiratory tract disease (RSV-LRTD, primary objective), severe RSV-LRTD, and RSV-ARI. Logistic regression with confounder adjustment was used to calculate vaccine effectiveness (VE) as (1 - adjusted odds ratio) × 100%. Results:Of 1012 infants hospitalized with ARI, 655 had LRTD, with 114 of 386 case infants (30%) and 171 of 269 control infants (64%) born to RSVpreF-vaccinated mothers (median [IQR] gestational age at vaccination, 31 weeks [29-33]). Median (IQR) maternal age at delivery was 32 years (29-35). Median (IQR) age of infants hospitalized for LRTD was 52 days (30-89); 495 of 655 (76%) were aged 3 months or younger. VE against RSV-LRTD hospitalization was 77.8% (95% CI, 66.4%-85.3%) among infants from birth through 6 months of age, 80.2% (95% CI, 71.1%-86.5%) among infants from birth through 3 months of age, 86.3% (95% CI, 79.0%-91.1%) among infants from birth through 2 months of age, and 68.2% (95% CI, 42.2%-82.5%) among infants older than 2 months through 4 months of age. Comparable VE among infants aged 6 months or younger was observed for severe RSV-LRTD (80.4%; 95% CI, 54.4%-91.6%) and RSV-ARI (80.8%; 95% CI, 70.4%-87.6%) hospitalization, with similar age-specific trends. VE was consistent across stratifications by gestational age at vaccination, vaccination to delivery time interval, and proximal administration with other vaccines during pregnancy. Descriptively, among all infants hospitalized with ARI, 161 of 499 (32%) born to RSVpreF-unvaccinated mothers had severe LRTD, while 87 of 513 (17%) born to RSVpreF-vaccinated mothers had severe LRTD. Conclusions and Relevance:Findings in this case-control study demonstrate high year-round effectiveness of RSVpreF vaccination against RSV-associated hospitalization in infants 6 months of age or younger in the first year following introduction in Australia, with the highest VE observed in the earliest age intervals. Future analyses with larger sample sizes will evaluate VE among additional subgroups.
Importance:Emergency department (ED) pediatric readiness and pediatric inpatient services have changed over time in many hospitals, but the impact of these changes on pediatric outcomes is unclear. Objective:To evaluate pediatric mortality associated with changes to ED pediatric readiness and pediatric inpatient services over a 10-year period. Design, Setting, and Participants:This cohort study included data from January 1, 2012, through December 31, 2021, for 759 hospitals in 11 states that completed the 2013 and 2021 National Pediatric Readiness Program assessments. Participants were children aged 0 to 17 years who received care in an ED resulting in hospital admission, interhospital transfer, or death. Data analysis was performed from May 2025 to May 2026. Exposure:Changes in ED pediatric readiness and inpatient pediatric services, as measured through national assessments in 2013 and 2021. ED readiness change groups were characterized based on the weighted Pediatric Readiness Score (wPRS, range 0-100) associated with survival (wPRS ≥88 vs wPRS <88): sustained high readiness, gained, lost, or never had. Changes in pediatric inpatient services were defined as sustained, gained, lost, or never had. Main Outcomes and Measures:In-hospital mortality, including ED and inpatient deaths. Results:There were 2 416 030 children, including 337 167 who were injured (median [IQR] age, 10 [4-15] years; 4642 deaths [1.38%]) and 2 078 863 who were medically ill (median [IQR] age, 6 [1-14] years; 18 576 deaths [0.89%]). Of the 759 hospitals, the median (IQR) wPRS in 2013 vs 2021 was 71 (58-86) and 72 (62-88), respectively. Ninety-nine EDs (13.0%) had sustained high readiness, 85 (11.2%) gained readiness, 78 (10.3%) lost readiness, and 497 (65.5%) never had high readiness. For inpatient services, 225 hospitals (29.6%) sustained inpatient services, 36 (4.7%) gained services, 120 (15.8%) lost services, and 378 (49.8%) never had services. After risk adjustment, EDs that lost or never had high ED readiness were associated with 1727 (95% CI, 751-2646) and 3776 (95% CI, 2327-5143) excess deaths, respectively. Hospitals that lost or never had inpatient services were associated with 1657 (95% CI, 1214-2067) and 3745 (95% CI, 3127-4328) excess deaths, respectively. Conclusions and Relevance:This study found that the loss or persistent lack of high ED pediatric readiness and pediatric inpatient services were independently associated with excess mortality in children. Increasing ED readiness and adding inpatient services may augment pediatric survival in the US health care system.
Importance:Concerns about screen use and early language development are widespread, and prior research has reported mixed findings. Many studies have not distinguished baseline differences from developmental change, leaving uncertainty about whether screen use is associated with actual language development in early childhood. Objective:To examine associations between children's and parental screen use and children's language development from ages 5 to 7 years. Design, Setting, and Participants:This population-based prospective cohort study included children recruited through municipalities across Norway in 2023. Children were followed up annually for 3 waves. Data were analyzed from September 2025 to March 2026. Exposures:Parent-reported child daily screen time (weekday and weekend weighted average), child digital device ownership, maternal and paternal daily social media use, and primary parent smartphone screen time at the onset of the study. Main Outcomes and Measures:Receptive vocabulary and receptive grammar were assessed annually using the British Picture Vocabulary Scale and the Test for Reception of Grammar. Latent growth modeling was used to estimate baseline language levels and developmental trajectories from ages 5 to 7 years, adjusting for parental education and household income. Results:A total of 747 children (mean [SD] age, 4.9 [0.3] years; 360 of 718 female [50.1%]) were included in this study. Most screen use indicators were not associated with children's language growth. However, primary parent smartphone screen time was associated with slower growth in receptive vocabulary; each additional 1 hour per day was associated with 0.42 slower annual growth in receptive vocabulary raw score (95% CI, -0.66 to -0.18). Children who owned a digital device at age 4 to 5 years scored lower at baseline as follows: 5.13 points lower in receptive vocabulary (95% CI, -7.43 to -2.82) and 4.56 points lower in receptive grammar (95% CI, -7.56 to -1.55) compared with children who did not own a device. Conclusions and Relevance:In this cohort study, primary parent smartphone screen time was associated with slower growth in children's receptive vocabulary, whereas children's digital device ownership was associated with lower concurrent language performance. These findings highlight the importance of considering screen use within the broader family context when evaluating children's language development and are potentially informative for parents and clinicians.
This Viewpoint highlights several considerations important for stakeholders and reviewers to understand regarding the design, evaluation, and interpretation of trials using bayesian analyses.
This Viewpoint proposes a surveillance framework for traumatic brain injury in pediatric patients with the recommendation for rapid magnetic resonance imaging (MRI) instead of repeat computed tomography (CT) after index CT establishes a diagnosis.
Importance National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission. Objective To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations. Design, Setting, and Participants This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026. Exposures Oseltamivir receipt as a time-dependent exposure. Main Outcome(s) and Measure(s) The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used. Results After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity—the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21). Conclusions and Relevance In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.
Importance:The consistency of nirsevimab effectiveness across consecutive seasons and its broader clinical protective effects remain to be fully characterized. Objective:To assess whether first-season effectiveness of nirsevimab against respiratory syncytial virus (RSV)-lower respiratory tract infection (LRTI)-related hospitalizations is maintained during a new RSV season, whether the effectiveness persists beyond the first season, and whether nirsevimab exposure is associated with hospitalizations for non-RSV infections and asthma during the first and second years of follow-up. Design, Setting, and Participants:This cohort study analyzed 2 nationwide matched cohorts using the French National Health Data System, including infants born in metropolitan France before the 2023 and 2024 immunization campaigns. Infants receiving nirsevimab were matched 1:1 to unimmunized infants. Both cohorts were followed up for 1 year after immunization, with an additional second year of follow-up for the 2023 cohort. Data analysis was performed from February 2023 to August 2025. Exposures:Single dose of nirsevimab. Main Outcomes and Measures:RSV-LRTI-related, non-RSV infection, and asthma hospitalizations were assessed using weighted Cox proportional hazards models. Results:This cohort study included 74 672 infants in 2023 and 175 526 in 2024. At baseline, the mean (SD) age of immunized infants was 4.5 (2.0) months in the 2023 cohort; 19 633 (52.6%) were male and 17 703 (47.4%) were female. The mean (SD) age of the 2024 cohort was 4.8 (2.2) months; 44 863 immunized infants (51.1%) were male and 42 900 (48.9%) were female. Among 37 366 infant pairs in 2023 and 87 763 pairs in 2024, RSV-LRTI-related hospitalizations during the first year of follow-up occurred in 299 (0.8%) immunized vs 899 (2.4%) unimmunized infants in 2023 and 456 (0.5%) vs 1711 (1.9%), respectively, in 2024. Nirsevimab was associated with a lower rate of RSV-LRTI-related hospitalization in both the 2023 and 2024 cohort during the first year of follow-up, with effectiveness estimates of 66% (95% CI, 61%-70%) and 72% (95% CI, 69%-75%), respectively. An association with higher rates of hospitalization for ear, nose, and throat (ENT) bacterial infections was observed (2023 cohort: weighted hazard ratio [wHR], 1.36; 95% CI, 1.00-1.84; 2024 cohort: wHR, 1.43; 95% CI, 1.15-1.78). No significant association was observed for other outcomes. During the second year of follow-up, no protective association was observed for RSV-LRTI-related hospitalization (wHR, 1.03; 95% CI, 0.73-1.43). An association with higher rates of hospitalization for ENT (wHR, 1.56; 95% CI, 1.10-2.22) and asthma (wHR, 1.24; 95% CI, 1.05-1.46) was observed. Conclusions and Relevance:This study found that nirsevimab was associated with a substantial reduction in RSV-LRTI-related hospitalizations during the first year across both the 2023-2024 and 2024-2025 seasons. It was not associated with reduced hospitalizations due to non-RSV infections or asthma, nor during the second year of follow-up.
