{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:01:29Z","timestamp":1791414089034,"version":"4.3.3"},"reference-count":53,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,12,1]]},"abstract":"<jats:p>Objective. In adults, posttraumatic stress disorder (PTSD) is associated with adverse health outcomes and high medical utilization and cost. PTSD is twice as common in women and is associated with increased risk for a range of diseases, chronic conditions, and reproductive-health problems. Little is known about the health effects of PTSD in children. The purpose of this study was to explore patterns of physical comorbidity in female children and adolescents with PTSD by using population data.<\/jats:p>\n               <jats:p>Methods. This study was a cross-sectional, descriptive epidemiologic case-control analysis of a Midwestern state's Medicaid eligibility and paid-claims data for girls (0\u20138 years old) and teens (9\u201317 years old). Data were from 1994\u20131997. All those with the PTSD diagnostic code were compared with randomly selected controls in relation to 3 sets of outcomes: (1) International Classification of Diseases, Ninth Revision (ICD-9) categories of disease; (2) chronic conditions previously associated with sexual trauma and PTSD in women; and (3) reproductive-health problems. Analyses included bivariate odds ratios (OR) and logistic-regression models that control for the extent of insurance coverage and the independent associations of victimization and psychiatric comorbidity with the 3 sets of outcomes. The mental health covariate was categorical to allow consideration of a range of severity. There were 4 categories for the young girls: neither PTSD nor depression, PTSD without depression, depression without PTSD, and PTSD + depression. For the adolescent analysis, a fifth category reflecting a \u201ccomplex PTSD\u201d was added, defined as having PTSD complicated by a dissociative disorder or borderline personality disorder diagnosis.<\/jats:p>\n               <jats:p>Results. There were 647 girls and 1025 adolescents with the PTSD diagnosis. Overall, PTSD was associated with adverse health outcomes in both age strata. Victimization was sometimes independently associated with adverse health outcomes, but PTSD often was a mediator, especially in the adolescent age stratum. The importance of PTSD diagnosis as a predictor of the ICD-9 categories of disease or chronic conditions seemed to increase with age.<\/jats:p>\n               <jats:p>In the younger age stratum, the increased bivariate ORs of significant associations with PTSD ranged from 1.4 for digestive disorders to 3.4 for circulatory disorders. Among younger girls, PTSD diagnosis was associated with significantly greater bivariate odds for 9 of the 12 ICD-9 categories of disease but not for neoplasms, blood disorders, or respiratory disorders and with threefold increased odds for chronic fatigue. They also had 1.8 times greater odds for sexually transmitted infections, some of which could be from congenital transmission in this age group, which includes infants. In the multivariate models for the young girls, the mental health variable seemed to mediate the relationship between victimization and increased odds of infectious and parasitic diseases, endocrine\/metabolic\/immune disorders, circulatory diseases, skin and cutaneous tissue disorders, and having any 1 of the 5 chronic conditions. The mental health categories that were significantly associated with health outcomes varied across the conditions. There were no health outcomes in which the depression-without-PTSD category was the only one significantly associated with the outcome condition. Circulatory and musculoskeletal disorders were significantly associated with all 3 of the mental health categories. Having any 1 of the 5 chronic conditions was significantly associated only with simple PTSD (PTSD without depression). Genitourinary disorders and signs\/symptoms\/ill-defined conditions were significantly associated with both simple and comorbid PTSD. PTSD with comorbid depression, the most severe of the mental health categories in this younger age group, was the only category associated with the endocrine\/metabolic\/immune disorders and skin disorders outcomes.<\/jats:p>\n               <jats:p>In the adolescent age stratum, the bivariate ORs significantly associated with PTSD ranged from 2.1 for blood disorders to 5.2 for irritable bowel syndrome. Adolescents with PTSD were nearly twice as likely to have a sexually transmitted infection and 60% more likely to have cervical dysplasia. However, their rate of pregnancy was lower (23% vs 31%), a one-fourth decreased odds. In the adolescent group, only 4 outcomes (nervous system\/sense organ, digestive, and genitourinary disorders and signs\/symptoms\/ill-defined conditions) remained statistically significantly associated with victimization after the mental health variable was added, suggesting an additive model of risk for these outcomes but a mediating role for PTSD in relation to the majority of the health outcomes. Among the adolescent girls, the range of ORs for the ICD-9 and chronic-condition diagnoses generally increased across the categories of the mental health variable in a dose-response pattern. Compared with adolescents with neither PTSD nor depression, those with PTSD without depression had statistically significant ORs from 1.5 to 3.6. Those with depression without PTSD had statistically significant ORs from 1.9 to 4.4. The significant ORs for those with PTSD comorbid with depression were from 2.3 to 6.6, and those in the complex-PTSD category had significant ORs of between 2.5 and 14.9. Only blood disorders seemed to be more strongly associated with depression alone than with the comorbid and complex forms of PTSD. The simple-PTSD category was not significantly associated with blood disorders, chronic pelvic pain, fibromyalgia, or dysmenorrhea. Depression without PTSD was not significantly associated with chronic pelvic pain or fibromyalgia. Fibromyalgia was only significantly associated with complex PTSD.<\/jats:p>\n               <jats:p>Conclusions. In young girls who receive Medicaid benefits, PTSD was associated with increased odds of a range of adverse health conditions. The pattern and odds of physical comorbidity among adolescent recipients with PTSD was nearly as extensive as that seen in adult women. Overall, the pattern observed suggests that objective disease states (eg, circulatory problems, infections) may be associated with PTSD to an extent nearly as great as that of PTSD with more subjective somatic experience of loss of wellness. Using the concepts of allostatic load and allostatic support, professionals who work with children and adolescents may be able to decrease the toll that traumatic stress takes on health even if available interventions can only be thought of as supportive and fall short of completely preventing trauma exposure or completely healing posttraumatic stress. Clinical research to extend these exploratory findings is warranted.<\/jats:p>","DOI":"10.1542\/peds.2005-0608","type":"journal-article","created":{"date-parts":[[2005,12,1]],"date-time":"2005-12-01T20:44:17Z","timestamp":1133469857000},"page":"e767-e776","source":"Crossref","is-referenced-by-count":128,"title":["Posttraumatic Stress Disorder and Physical Comorbidity Among Female Children and Adolescents: Results From Service-Use Data"],"prefix":"10.1542","volume":"116","author":[{"given":"Julia S.","family":"Seng","sequence":"first","affiliation":[{"name":"Institute for Research on Women and Gender"},{"name":"School of Nursing, and Departments of"},{"name":"Obstetrics and Gynecology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Graham-Bermann","sequence":"additional","affiliation":[{"name":"Psychology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kathleen","family":"Clark","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"McCarthy","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Ronis","sequence":"additional","affiliation":[{"name":"School of Nursing, and Departments of"},{"name":"Ann Arbor VA Medical Center, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,12,1]]},"reference":[{"key":"2021121003212277300_R1","unstructured":"Kimerling R, Ouimette P, Wolfe J, eds. Gender and PTSD. New York, NY: Guilford Publications; 2002"},{"key":"2021121003212277300_R2","doi-asserted-by":"crossref","unstructured":"Ouimette P, Cronkite R, Henson BR, Prins A, Gima K, Moos RH. Posttraumatic stress disorder and health status among female and male medical patients. J Trauma Stress.\u20082004;17:1\u20139","DOI":"10.1023\/B:JOTS.0000014670.68240.38"},{"key":"2021121003212277300_R3","doi-asserted-by":"crossref","unstructured":"Kimerling R, Calhoun KS. Somatic symptoms, social support, and treatment seeking among sexual assault victims. J Consult Clin Psychol.\u20081994;62:333\u2013340","DOI":"10.1037\/0022-006X.62.2.333"},{"key":"2021121003212277300_R4","doi-asserted-by":"crossref","unstructured":"Irwin C, Falsetti SA, Lydiard RB, Ballenger JC, Brock CD, Brener W. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. J Clin Psychiatry.\u20081996;57:576\u2013578","DOI":"10.4088\/JCP.v57n1204"},{"key":"2021121003212277300_R5","doi-asserted-by":"crossref","unstructured":"Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I. Association of posttraumatic stress disorder with pregnancy complications. Obstet Gynecol.\u20082001;97:17\u201322","DOI":"10.1097\/00006250-200101000-00004"},{"key":"2021121003212277300_R6","doi-asserted-by":"crossref","unstructured":"Seng JS, Clark MK, McCarthy AM, Ronis DL. PTSD and physical co-morbidity among women receiving Medicaid: results from service use data. J Trauma Stress.\u20082005; In press","DOI":"10.1002\/jts.20097"},{"key":"2021121003212277300_R7","unstructured":"Breslau N. Outcomes of posttraumatic stress disorder. J Clin Psychiatry.\u20082001;62(suppl 17):55\u201359"},{"key":"2021121003212277300_R8","doi-asserted-by":"crossref","unstructured":"Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1900s. J Clin Psychiatry.\u20081999;60:427\u2013435","DOI":"10.4088\/JCP.v60n0702"},{"key":"2021121003212277300_R9","unstructured":"Office of Research on Women's Health. Agenda for Research on Women's Health for the 21st Century. Vol 1. Washington, DC: National Institutes of Health; 1999:48"},{"key":"2021121003212277300_R10","doi-asserted-by":"crossref","unstructured":"Schnurr PP, Green BL. Understanding the relationships among trauma, posttraumatic stress disorder and health outcomes. In: Schnurr PP, Green BL, eds. Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association; 2004:247\u2013276","DOI":"10.1037\/10723-010"},{"key":"2021121003212277300_R11","doi-asserted-by":"crossref","unstructured":"Lang AJ, Rodgers CS, Laffaye C, Satz LE, Deresslhaus TR, Stein MB. Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med.\u20082003;28:150\u2013159","DOI":"10.1080\/08964280309596053"},{"key":"2021121003212277300_R12","doi-asserted-by":"crossref","unstructured":"Goodwin RD, Stein MB. Association between childhood trauma and physical disorders among adults in the United States. Psychol Med.\u20082004:34;509\u2013520","DOI":"10.1017\/S003329170300134X"},{"key":"2021121003212277300_R13","doi-asserted-by":"crossref","unstructured":"Seng JS. A conceptual framework for research on lifetime violence, posttraumatic stress, and childbearing. J Midwifery Womens Health.\u20082002;47:337\u2013346","DOI":"10.1016\/S1526-9523(02)00275-1"},{"key":"2021121003212277300_R14","doi-asserted-by":"crossref","unstructured":"Breslau N, Davis GC, Peterson EL, Schultz LR. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry.\u20081997;54:81\u201387","DOI":"10.1001\/archpsyc.1997.01830130087016"},{"key":"2021121003212277300_R15","doi-asserted-by":"crossref","unstructured":"Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS. Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. J Trauma Stress.\u20081997;10:539\u2013555","DOI":"10.1002\/jts.2490100403"},{"key":"2021121003212277300_R16","doi-asserted-by":"crossref","unstructured":"Kilpatrick DG, Acierno R, Saunders B, Resnick HS, Best CL, Schnurr PP. Risk factors for adolescent substance abuse and dependence: data from a national sample. J Consult Clin Psychol.\u20082000;68:19\u201330","DOI":"10.1037\/0022-006X.68.1.19"},{"key":"2021121003212277300_R17","doi-asserted-by":"crossref","unstructured":"Dietz PM, Spitz AM, Anda RF, et al. Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA.\u20081999;282:1359\u20131364","DOI":"10.1001\/jama.282.14.1359"},{"key":"2021121003212277300_R18","doi-asserted-by":"crossref","unstructured":"Hoksbergen RA, ter Laak J, van Dijkum C, Rijk S, Rijk K, Soutjesdijk F. Posttraumatic stress disorder in adopted children from Romania. Am J Orthopsychiatry.\u20082003;73:255\u2013265","DOI":"10.1037\/0002-9432.73.3.255"},{"key":"2021121003212277300_R19","doi-asserted-by":"crossref","unstructured":"Mollica RF, Poole C, Son L, Murray CC, Tor S. Effects of war trauma on Cambodian refugee adolescents' functional health and mental health status. J Am Acad Child Adolesc Psychiatry.\u20081997;36:1098\u20131106","DOI":"10.1097\/00004583-199708000-00017"},{"key":"2021121003212277300_R20","doi-asserted-by":"crossref","unstructured":"Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E. Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry.\u20081995;34:1369\u20131380","DOI":"10.1097\/00004583-199510000-00023"},{"key":"2021121003212277300_R21","doi-asserted-by":"crossref","unstructured":"Stuber ML, Shemesh E, Saxe GN. Posttraumatic stress responses in children with life-threatening illnesses. Child Adolesc Psychiatr Clin N Am.\u20082003;12:195\u2013209","DOI":"10.1016\/S1056-4993(02)00100-1"},{"key":"2021121003212277300_R22","doi-asserted-by":"crossref","unstructured":"Dew MA, Kormos RL, Roth LH, Murali S, DiMartini A, Griffith BP. Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant.\u20081999;18:549\u2013562","DOI":"10.1016\/S1053-2498(98)00044-8"},{"key":"2021121003212277300_R23","doi-asserted-by":"crossref","unstructured":"Shemesh E, Lurie S, Stuber ML, et al. A pilot study of posttraumatic stress and nonadherence in pediatric liver transplant recipients. Pediatrics.\u20082000;105(2). Available at: www.pediatrics.org\/cgi\/content\/full\/105\/2\/e29","DOI":"10.1542\/peds.105.2.e29"},{"key":"2021121003212277300_R24","doi-asserted-by":"crossref","unstructured":"Graham-Bermann SA, Seng JS. Violence exposure and traumatic stress symptoms as additional predictors of health problems in high risk children. J Pediatr.\u20082005;146:349\u2013354","DOI":"10.1016\/j.jpeds.2004.10.065"},{"key":"2021121003212277300_R25","unstructured":"Bloom B, Cohen RA, Vickerie JL, Wondimu EA. Summary health statistics for U.S. children: National Health Interview Survey, 2001. Vital Health Stat 10.\u20082003;(216):1\u201354"},{"key":"2021121003212277300_R26","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994"},{"key":"2021121003212277300_R27","doi-asserted-by":"crossref","unstructured":"Costello EJ, Erkanli A, Fairbank JA, Angold A. The prevalence of potentially traumatic events in childhood and adolescence. J Trauma Stress.\u20082002;15:99\u2013112","DOI":"10.1023\/A:1014851823163"},{"key":"2021121003212277300_R28","unstructured":"Fletcher KE. Childhood posttraumatic stress disorder. In: Mash EJ, Barkley RA, eds. Child Psychopathology. 2nd ed. New York, NY: Guilford Press; 2003:330\u2013371"},{"key":"2021121003212277300_R29","doi-asserted-by":"crossref","unstructured":"Kilpatrick DG, Ruggierio RA, Acierno R, Saunders BE, Resnick HS, Best CL. Violence and risk of PTSD, major depression, substance abuse\/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol.\u20082003;71:692\u2013700.","DOI":"10.1037\/0022-006X.71.4.692"},{"key":"2021121003212277300_R30","doi-asserted-by":"crossref","unstructured":"Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson C. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry.\u20081995;52:1048\u20131060","DOI":"10.1001\/archpsyc.1995.03950240066012"},{"key":"2021121003212277300_R31","doi-asserted-by":"crossref","unstructured":"van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFarlane AC, Herman JL. Dissociation, somatization, and affect dysregulation: the complexity of adaptation to trauma. Am J Psychiatry.\u20081996;153(7 suppl):83\u201393","DOI":"10.1176\/ajp.153.7.83"},{"key":"2021121003212277300_R32","unstructured":"Practice Management Information Corporation. International Classification of Diseases, 9th Revision, Clinical Modification. 5th ed. Los Angeles, CA: Practice Management Information Corporation; 1998"},{"key":"2021121003212277300_R33","unstructured":"Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB, eds. Designing Clinical Research. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2001:95\u2013105"},{"key":"2021121003212277300_R34","unstructured":"Hintze JL. PASS 2000 User's Guide. Kaysville, UT: Number Cruncher Statistical Software; 2000"},{"key":"2021121003212277300_R35","unstructured":"Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988"},{"key":"2021121003212277300_R36","doi-asserted-by":"crossref","unstructured":"Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health.\u20081988;79:340\u2013349","DOI":"10.2105\/AJPH.79.3.340"},{"key":"2021121003212277300_R37","unstructured":"Agresti A. Categorical Data Analysis. New York, NY: John Wiley & Sons; 1990"},{"key":"2021121003212277300_R38","unstructured":"Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol 1: The Analysis of Case-Control Studies. Oxford, United Kingdom: Oxford University Press; 1993"},{"key":"2021121003212277300_R39","unstructured":"Menard S. Applied Logistic Regression Analysis. Thousand Oaks, CA: Sage Publications; 1995"},{"key":"2021121003212277300_R40","doi-asserted-by":"crossref","unstructured":"Friedman MJ, McEwan BS. Posttraumatic stress disorder, allostatic load, and medical illness. In: Schnurr PP, Green BL, eds. Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association; 2004:157\u2013188","DOI":"10.1037\/10723-007"},{"key":"2021121003212277300_R41","unstructured":"Blount A, ed. Integrated Primary Care: The Future of Medical and Mental Health Collaboration. New York, NY: W. W. Norton & Company; 1998"},{"key":"2021121003212277300_R42","unstructured":"Kimerling R, Calhoun KS, Forehand R, et al. Traumatic stress in HIV-infected women. AIDS Educ Prev.\u20081999;11:321\u2013330"},{"key":"2021121003212277300_R43","doi-asserted-by":"crossref","unstructured":"Arata CM. Sexual revictimization and PTSD: an exploratory study. J Child Sex Abus.\u20081999;8:49\u201365","DOI":"10.1300\/J070v08n01_04"},{"key":"2021121003212277300_R44","doi-asserted-by":"crossref","unstructured":"Chilcoat HD, Breslau N. Posttraumatic stress disorder and drug disorders: testing causal pathways. Arch Gen Psychiatry.\u20081998;55:913\u2013917","DOI":"10.1001\/archpsyc.55.10.913"},{"key":"2021121003212277300_R45","doi-asserted-by":"crossref","unstructured":"Sandberg DA, Matorin AL, Lynn SJ. Dissociation, posttraumatic symptomatology and sexual revictimization: a prospective examination of mediator and moderator effects. J Trauma Stress.\u20081999;12:127\u2013138","DOI":"10.1023\/A:1024702501224"},{"key":"2021121003212277300_R46","doi-asserted-by":"crossref","unstructured":"Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski, P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry.\u20081998;55:626\u2013632","DOI":"10.1001\/archpsyc.55.7.626"},{"key":"2021121003212277300_R47","unstructured":"Winterbottom C, Liska DW, Obermaier KM. State-Level Databook on Health Care Access and Financing. 2nd ed. and supplement. Washington, DC: Urban Institute; 1995"},{"key":"2021121003212277300_R48","unstructured":"Health Care Financing Administration. Medicaid Statistics, Program, and Financial Statistics, Fiscal Year 1994. Baltimore, MD: US Department of Health and Human Services; 1996"},{"key":"2021121003212277300_R49","unstructured":"Health Care Financing Administration. Medicare and Medicaid Statistical Supplement. Baltimore, MD: US Department of Health and Human Services; 1997"},{"key":"2021121003212277300_R50","unstructured":"Henry Kaiser Family Foundation. StateHealthFacts. Available at: www.statehealthfacts.org. Accessed December 28, 2004"},{"key":"2021121003212277300_R51","unstructured":"Waldrop J, Stern SM. Disability status: 2000. US Census brief C2KBR-17. 2003. Available at: www.census.gov\/prod\/2003pubs\/c2kbr-17.pdf. Accessed December 28, 2004"},{"key":"2021121003212277300_R52","unstructured":"US Census Bureau. 2000 Census Factfinder data for the State of Michigan. Available at: www.factfinder.census.gov\/servlet\/SAFFFacts?_event=Search&geo_id=&_geoContext=&_street=&_county=&_cityTown=&_state=04000US26&_zip=&_lang=en&_sse=on&pctxt=fph&pgsl=010. Accessed December 28, 2004"},{"key":"2021121003212277300_R53","doi-asserted-by":"crossref","unstructured":"Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA.\u20081998;280:1690\u20131691","DOI":"10.1001\/jama.280.19.1690"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/116\/6\/e767\/1067800\/zpe0120500e767.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/116\/6\/e767\/1067800\/zpe0120500e767.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T09:57:59Z","timestamp":1639130279000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/116\/6\/e767\/62971\/Posttraumatic-Stress-Disorder-and-Physical"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,12,1]]},"references-count":53,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2005,12,1]]},"published-print":{"date-parts":[[2005,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2005-0608","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,12,1]]}}}