This randomized, controlled trial was designed to document the effectiveness of Child FIRST (Child and Family Interagency, Resource, Support, and Training), a home-based, psychotherapeutic, parent-child intervention embedded in a system of care. Multirisk urban mothers and children, ages 6-36 months (N = 157) participated. At the 12-month follow-up, Child FIRST children had improved language (odds ratio [OR] = 4.4) and externalizing symptoms (OR= 4.7) compared to Usual Care children. Child FIRST mothers had less parenting stress at the 6-month follow-up (OR = 3.0), lower psychopathology symptoms at 12-month follow-up (OR = 4.0), and less protective service involvement at 3 years postbaseline (OR = 2.1) relative to Usual Care mothers. Intervention families accessed 91% of wanted services relative to 33% among Usual Care. Thus, Child FIRST is effective with multirisk families raising young children across multiple child and parent outcomes.

There is significant controversy about the role of bronchodilator therapy for wheezing in infants. A double-blind, randomized trial of subcutaneous epinephrine v normal saline was conducted in children <24 months of age evaluated at Yale-New Haven Hospital. Respiratory assessments using a newly developed Respiratory Distress Assessment Instrument were made at baseline and 15 minutes after each of two injections. Relief of respiratory distress was assessed using strict a priori criteria based on changes in respiratory rate, wheezing, and retractions as scored in the Respiratory Distress Assessment Instrument. Significantly more children improved their respiratory status with epinephrine (nine of 16) than placebo (one of 14) (Fisher exact test, P = .0067). Paired data in individuals receiving placebo and then epinephrine confirmed this (Wilcoxon signed ranks test, P < .01). Sixty-three percent of patients <12 months and 92% of those 12 to 24 months improved with epinephrine, as did seven of ten children with respiratory syncytial virus bronchiolitis. In many children, response to the initial epinephrine injection was not indicative of final response. Results of this study demonstrate the effectiveness of epinephrine in the treatment of acute wheezing in children <24 months of age.