Cornelius Botha Groenewald

Introduction: Neurodevelopmental disorders (NDDs) affect up to 15% of children in the United States and are associated with co-occurring health challenges such as chronic pain, which can negatively affect development and quality of life. Increased risk of chronic pain in children with NDDs remains poorly understood; this study aimed to estimate chronic pain prevalence among children with NDDs and explore whether this association differs by sex. Methods: We conducted a cross-sectional analysis of children participating in the 2022 to 2023 National Survey of Children's Health (age 3–17 years, n = 84,117). Neurodevelopmental disorders included attention deficit and hyperactivity disorder, autism, intellectual disability, speech disorder, Tourette syndrome, learning disability, and developmental delay. Chronic pain was defined as frequent or persistent pain in the past 12 months. Weighted multivariable logistic regression estimated associations between NDDs and chronic pain, adjusting for sociodemographic and health covariates. Results: Overall, 18.7% (95% confidence interval: 18.2%–19.2%) of children had an NDD. Chronic pain prevalence was higher among children with NDDs than among those without (10.3% vs 5.2%, P < 0.001). After adjustment, children with any NDD (aOR 1.9 [1.7–2.2]) had increased odds of chronic pain. Tourette syndrome showed the greatest odds (aOR = 3.2 [1.7–6.2]). Sex did not alter the association between NDDs and chronic pain ( P = 0.79). Conclusion: Neurodevelopmental disorders affect 1 in 6 U.S. children and are associated with almost double the odds of chronic pain. This increased odds emphasizes the need for improved chronic pain recognition and management among children with NDDs. Future research should examine chronic pain in youth with NDDs, to improve assessment, management, and understanding of pain mechanisms.

To determine national health care expenditures associated with sleep disorders among children and adolescents in the United States. We conducted secondary analyses of the 2017-2022 Medical Expenditure Panel Survey (MEPS), including children 0-18 years of age (n = 41,384). Children with sleep disorders were identified by International Classification of Diseases, 10th Revision code G47.x. Multivariate two-part models, adjusting for covariates, were used to estimate associations between sleep disorders and health care expenditures. Among MEPS participants, on average 1.1% (95% CI: 0.9-1.3%) were diagnosed with a sleep disorder, representing 855,000 children diagnosed nationwide each year. Children with sleep disorders were more likely to be White, non-Hispanic (66.2%), categorized as having poor/near poor income (31.8%), on public insurance only (60.2%), and have significantly higher values on pediatric comorbidity index scores (2.7 vs. 0.3). The presence of a sleep disorder was associated with $3240 (95% CI: $2060-$4421, p < 0.0001) in incremental health care expenditures as compared to not having a sleep disorder ($5897 versus $2656), after controlling for predisposing, enabling, and need factors. National expenditures associated with childhood sleep disorders were estimated at $2.88 billion annually. Childhood sleep disorders exert a significant economic burden on society. Our analyses likely underestimate the total economic costs associated with childhood sleep disorders. Although the varied health outcomes of childhood sleep disorders are well understood, the national economic impacts of these disorders are poorly described. This information is important, as the estimated prevalence of these disorders in the pediatric population is high, and understanding the cost of these disorders could provide support for efforts promoting their early diagnosis and treatment. We found that the incremental health care costs associated with childhood sleep disorders were significant, amounting to $2.88 billion in annual expenditures. This high cost highlights the need for more effective strategies to prevent and manage pediatric sleep disorders.

Background: High‐risk substance use is a public health concern among adolescents placing them at increased likelihood for opioid misuse and overdose. However, whether high‐risk substance use is associated with increased postoperative opioid use remains poorly described. This study aimed to determine whether preoperative high‐risk substance use is associated with increased postoperative opioid use in adolescents. Methods: This longitudinal study included opioid‐naive adolescents undergoing ambulatory orthopedic surgery. Preoperative high‐risk substance use was stratified using the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD). Postoperative opioid dose use was recorded with an objective electronic medication adherence device. Postoperative pain was reported every 4 h using a smartphone diary. Multivariable regression analyses for cross‐sectional data and multivariable mixed modeling for longitudinal data were performed. Results: Participants ( n 121) aged 15 years (mean; range 11–19) (49% females) had mostly knee, some shoulder and elbow surgery. Only 13/121 (10.7%) reported high substance use risk, none reported low risk, with the majority (89.3%) reporting no substance intake in the prior 12 months. Patients with high‐risk preoperative substance use took twice the postoperative opioid doses compared to those with no use 12.2 (2.7) versus 5.6 (0.6) ( p < 0.0001). Multivariate negative binomial regression analysis, controlling for sociodemographic and clinical factors, confirmed high‐risk preoperative substance use was associated with increased postoperative opioid dose use (incidence rate ratio 1.96, 95% CI: 1.12–3.43, p = 0.018). Longitudinal analysis over 14 days revealed that while adolescents with high‐risk substance use overall used more opioids for their pain, they were also less likely to vary their opioid use in response to lower levels of pain intensity as compared to adolescents without substance use. Conclusions: High‐risk preoperative substance use was associated with increased postoperative opioid use in opioid‐naïve adolescents following elective ambulatory orthopedic surgery. These findings, although limited by small sample size, highlight the need for presurgery substance use screening to guide personalized strategies, potentially reduce opioid use, improve pain management, and lower misuse risk.

Air pollution poses increasing risks to pediatric health, yet associations between ambient air pollutants and chronic pain in children remain poorly described. We examined whether ambient air pollutants are associated with chronic pain in a national sample of US children. We conducted a cross-sectional study linking data from 54,880 children aged 0–17 years in the 2023 National Survey of Children's Health (NSCH) to US Environmental Protection Agency (EPA) state-level air pollution estimates. Parents reported whether their child experienced chronic or frequent pain in the past 12 months. Survey-weighted logistic regression estimated associations between seven pollutants (PM2·5, PM10, PM10-2·5, O3, SO2, NO2, NO) and chronic pain, adjusting for age, sex, income, and asthma. Principal component analysis (PCA) characterized pollutant mixtures. Chronic pain prevalence was 5·1%, with higher rates among adolescents, females, and low-income households. Sulfur dioxide (SO2) was significantly associated with chronic pain after false discovery rate correction (aOR 1·08, 95% CI 1·02–1·13, p=0·004, q=0·028). PCA-derived mixture scores were not associated with chronic pain, and SO2 loaded weakly on both PCs, suggesting it captures independent variance from distinct industrial emission sources. SO2, a marker of industrial combustion and fossil fuel burning, was the only pollutant associated with pediatric chronic pain in this nationally representative sample. This association may reflect neuroinflammatory pathways linking combustion-derived pollution to pain sensitization. Future studies with finer-scale exposure assessment are needed to confirm these findings.