ImportanceLittle is known about the risk factors for, and the risk of, developing post–COVID-19 conditions (PCCs) among children.ObjectivesTo estimate the proportion of SARS-CoV-2–positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2–negative children, and to assess factors associated with PCCs.Design, Setting, and ParticipantsThis prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2–positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2–negative controls.ExposureSARS-CoV-2 detected via nucleic acid testing.Main Outcomes and MeasuresPost–COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey.ResultsOf 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2–positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2–positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2–positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]).Conclusions and RelevanceIn this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.

Background The J tip uses air instead of a needle to push lidocaine into the skin. No studies have investigated its use for venipuncture in young children. Objective Determine if J tip decreased venipuncture pain in young children compared to vapocoolant spray. Methods Children ages 1 to 6 years were randomized into 3 groups: Intervention – J tip, Control –vapocoolant spray, and Sham –vapocoolant spray and “pop” of an empty J tip. The procedure was videotaped and scored using the FLACC tool at three times; Baseline - before approach, Device - J tip deployment and Venipuncture - venipuncture. The FLACC tool was scored 0(none) to 10(severe). Comparisons of pain scores over time were made using the Generalized Estimating Equation. Venipuncture success and adverse effects were assessed and compared using Χ2. Results 205 children enrolled; Intervention=96, Control=53, Sham=56. There were no between group differences in baseline characteristics. There was no mean change in pain scores from Device to Venipuncture in the Intervention group (0.25, 95% CI (−0.31, 0.82) but there was an increase in pain in the Control (2.82, 95% CI (1.91, 3.74) and Sham (1.68, 95% CI (0.83, 2.52) groups. This change was greater for the Control and Sham compared to the Intervention group. There was no difference in venipuncture success between groups. No severe adverse events occurred. Minor adverse events were the same between groups. Conclusion Use of the J tip for children ages 1 to 6 years reduced venipuncture pain compared to vapocoolant spray or sham treatment.

IMPORTANCESevere outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including

Objective Needle Free Jet Injection system with buffered lidocaine (J tip) has been shown to reduce pain for intravenous line (IV) insertion, but its relationship with successful IV placement has not been well studied. This study aimed to determine if J tip use is associated with improved first attempt IV placement success in children Methods This was a retrospective cohort study of children ages 1 to 18 years with emergent IV placement. Approximately 300 children were selected from each of three separate age groups: 1) 1 to 2 years, 2) 3 to 6 years and 3) 7 to 18 years. The standard treatment group (No Device) included children with an IV insertion from January 2009 through January 2010 with no J tip. The J tip treatment group (Device) included children with an IV insertion from December 2010 through December 2011 that received a J tip. Successful IV placement on first attempt was the primary outcome. Chi square test was used to compare the proportion of first attempt success and logistic regression was performed to assess the effect of device use and patient age, sex and race on first attempt success. Results A total of 958 children were enrolled, 501 in the No Device group and 457 in the Device group. The most common diagnoses were vomiting/dehydration (30.3%), trauma/burn (20.0%) and infection (15.5%). Overall, first attempt success was 69.0%; first attempt success was similar between the No Device (68.7%) and Device (69.4%) groups (p=0.81). No difference in first attempt success with the use of the Device was found in any of the age groups. Multivariate analysis found only age of 1 to 2 years was associated with lower odds of first attempt success. Conclusion The use of J tip was not associated with improved success on the first IV attempt for children. Treatment of pain during IV placement may not be sufficient to improve placement success.

The aim of this study was to determine if young children with high preprocedural anxiety experience increased pain at venipuncture. Methods:This was secondary analysis of prospectively obtained data from a randomized controlled trial comparing vapocoolant spray with jet-injected lidocaine for venipuncture pain. Children aged 1 to 6 years were enrolled and videotaped. Videos were reviewed and scored for anxiety using the modified Yale Preoperative Anxiety Scale score for preprocedural anxiety (score range, 23-100). High anxiety was defined as greater than 40. Pain at the time of venipuncture was scored using the Face, Legs, Activity, Cry, and Consolability scale (score range 0-10). Moderate to severe pain was defined as greater than 3. Logistic regression assessed patient factors associated with high preprocedural anxiety and evaluated the relationship between preprocedural anxiety and pain during venipuncture.Results: Two hundred five patients were enrolled; 59.5% of patients were male, and 53.7% were White. Mean age was 3.2 years. Prior to the procedure, 67% of patients had high anxiety. Patient age, race, sex, and previous venipuncture were not associated with increased odds of high anxiety. Moderate to severe pain at venipuncture was observed in 65% of children. High preprocedural anxiety was associated with increased odds of moderate to severe pain at venipuncture when controlled for patient characteristics (adjusted odds ratio, 4.62; 95% confidence interval, 2.03-8.54).Conclusions: Most young children undergoing venipuncture experienced high preprocedural anxiety. Children with high preprocedural anxiety had increased odds of moderate to severe pain at venipuncture. Anxiety-reducing interventions should be explored to reduce pain experienced during venipuncture.