Respiratory Syncytial Virus.

Respiratory syncytial virus (RSV) is a ubiquitous virus and infects nearly every child before their second birthday. Causing a wide array of symptoms, ranging from a mild cold to respiratory failure and even death, it is an illness that every general pediatrician will encounter on a yearly basis. It is important to know which populations are at risk for severe disease and what we can do to protect them from RSV and treat them if they do contract it. Many preventive measures are being studied, but so far, RSV has proved a challenging virus to capture and control. As our technology and knowledge grow, there is hope for a vaccine, more attainable and longer-lasting immunoprophylaxis, and better treatment options for those who do contract the disease. [Pediatr Ann. 2022;51(10):e376-e378.].

Diarrhea in Resource-Rich Countries: Common and Uncommon Causes.

Diarrhea is a major cause of illness worldwide despite advancements in sanitation, hygiene, education, and awareness. In resource-rich countries, death is a rare complication, but the health care and economic burden remains. Guidelines have been developed by the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition Working Group as well as the Infectious Diseases Society of America to help with the diagnosis and management of acute infectious diarrhea (the most common underlying reason for diarrhea). There are also guidelines available for the evaluation and management of more chronic forms of diarrhea. If we follow these diagnostic approaches and recommendations for management, we should be able to achieve a balance of providing appropriate care to our patients without performing excessive and unnecessary diagnostic testing. [Pediatr Ann. 2022;51(7):e260-e263.].

Overview of the Updates for the Management of Asthma Guidelines.

Asthma is a common diagnosis for pediatric patients, and something frequently managed in the primary care setting. Due to the multitude of factors that affect asthma, obtaining good control of the disease can be difficult. Managing triggers, medications, and adherence are key to maintaining good asthma control and quality of life. The National Heart, Lung, and Blood Advisory Council has released new guidelines and recommendations to help assist in the management of asthma. The expert panel addressed several key areas and made recommendations based on the available data. Areas addressed were the use of intermittent inhaled corticosteroids, the use of long-acting muscarinic antagonist, allergen mitigation, fractional exhaled nitric oxide testing for asthma diagnosis and management, and immune modulation for asthma control. This article summarizes the key recommendations and changes to the guideline. [Pediatr Ann. 2022;51(4):e132-e135.].

Molluscum and Tinea and Warts, Oh My!

The skin is the largest organ in the human body, and it acts as the barrier between the world and our bodies. As such, it is constantly being exposed to infections, irritants, and allergens. Approximately one-third of primary care visits involve at least one skin complaint. This may manifest as a rash, a lesion, pruritis, pigment changes, or textural abnormalities. Whatever the presentation, it is important to know the common causes of these skin abnormalities and the appropriate management. Just as important as management is the ability to set expectations for patients, as many common skin conditions can be difficult to treat and may take significant time to resolve. This article will highlight some of the most common skin lesions we see in pediatric patients. [Pediatr Ann. 2022;51(1):e2-e5.].

The Changing Face of Bullying and What We Can Do to Stop It.

Bullying is a pervasive problem that affects all races, religions, genders, and socioeconomic groups. It occurs primarily at school but can also follow children and adolescents to their home, work, and activities. In more recent years, bullying has also taken on a new form via digital and electronic means. The avenues for bullying are constantly evolving as society and technology evolve as well. Bullying can have a significant impact on both short-term health and functioning as well as long-term success and well-being. For this reason, it is important to be able to identify bullies and their victims and implement strategies to stop bullying before it occurs and manage the consequences when it does happen. [Pediatr Ann. 2021;50(10):e398-e401.].

Polycystic Ovarian Syndrome in Adolescents: Keys to Diagnosis and Management.

Polycystic ovarian syndrome (PCOS) is the most common endocrine condition in women, affecting anywhere from 3% to 13% depending on the population being studied. PCOS often begins in adolescence, but diagnosis is difficult due to the overlap of symptoms with normal puberty. It is also necessary to rule out other potential causes of these symptoms before diagnosis. Once diagnostic criteria have been met, there are many treatment options to consider including lifestyle changes, combined oral contraceptive pills, metformin, and in some cases, antiandrogens. [Pediatr Ann. 2021;50(7):e272-e275.].

Thyroid Disease in Children and Adolescents.

The thyroid plays a major role in growth and development, and the hormones it produces can affect many different systems of the body. For this reason, the thyroid should always be at the front of our minds when evaluating children and adolescents. The symptoms of thyroid abnormalities can often be subtle and evolve over time, so we must have a high index of suspicion when providing care for our patients. It is important to understand what can go wrong with the thyroid, how to diagnose thyroid disease, and how to manage thyroid abnormalities. Whether it is structural changes in the thyroid such as goiter or nodules, functional changes that lead to hyperthyroidism or hypothyroidism, or thyroid cancer, a thorough examination and appropriate treatment is essential to maintain optimal cognitive and physical growth throughout childhood and adolescence. This article will discuss the most common thyroid abnormalities, how to diagnose them, and how to treat and manage them in both the short and long term. [Pediatr Ann. 2021;50(4):e143-e147.].

Overview of Dyslipidemia in Childhood and Adolescence: Why Does It Matter and What Do We Do About It?

Cardiovascular disease is a leading cause of morbidity and mortality in adults in the United States. Cardiovascular health as a child and adolescent is important in setting the path for a heart-healthy life in adulthood. One major impact on cardiovascular health that can have its roots in childhood is dyslipidemia. Universal screening for all children is a newer concept that has emerged over the last decade; previously children and adolescents were screened based only on risk factors. This review addresses who is at risk for dyslipidemia, how and when to screen children and adolescents, why early identification is important, and how to manage dyslipidemia when it is diagnosed. There are many interventions that can be started in childhood to help decrease cardiovascular risk factors in adults, thus decreasing the morbidity and mortality from heart disease in the future. [Pediatr Ann. 2021;50(1):e4-e9.].

SARS-CoV-2 Infection in Children: Special Considerations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in Wuhan, Hubei province, China. Soon after, it was discovered to be a novel human virus and it subsequently spread throughout the world, leading to a global pandemic. From the experience we have so far with this virus, it appears that compared to most other respiratory viral illnesses to which they are typically highly susceptible, children are affected less by SARS-CoV-2 than adults. It will continue to be important to collect data and study different populations to learn more about how children are affected by the disease, particularly as we head back to school in different forms this fall. We also must pay close attention to whether or not children are significant transmitters of the disease, as this is largely unknown and will have an affect on those who are providing care for children at school, daycare, and at home. [Pediatr Ann. 2020;49(10):e407-e412.].

Staying Safe This Summer.

The arrival of summer brings more sunshine, more time outside, and more opportunities for recreation and play. Although these activities may look a little different this summer as a result of the coronavirus disease 2019 (COVID-19) pandemic, they also allow us to get outside, interact safely with others, and remain connected to our friends and communities. Along with fun activities and exercise, there also comes a need for heightened awareness of summertime safety. Because so many childhood activities occur during the summer, precautions must be taken to ensure the safety and health of our children. From appropriate sun protection and water safety to insect exposure and recreational precautions, it is important to review key safety points to ensure a happy and healthy season. As the COVID-19 pandemic is still very active, there will also be an added layer of complexity to staying safe this summer, including adapting activities to meet the guidelines of social distancing. This article addresses some of the most common dangers encountered during the summer months and offers protective measures to decrease risk and promote safety. [Pediatr Ann. 2020;49(7):e285-e289.].

Pediatric Hypertension.

Hypertension is an important and often overlooked problem in the pediatric population. In 2017, the American Academy of Pediatrics updated their guidelines for the diagnosis and management of hypertension. The new guidelines include a refined definition of the blood pressure stages and also a new diagnostic reference table with updated data excluding those with overweight or obesity. It also simplified the diagnostic criteria for adolescents and provided a screening table for easier use in the clinical setting. Along with the simplified diagnostic criteria, the new guidelines stress the importance of accurate blood pressure measurements and the growing importance of ambulatory blood pressure monitoring. With these revised guidelines, the diagnosis and management of blood pressure in the pediatric population should be clearer and easier to implement in clinical practice. [Pediatr Ann. 2020;49(4):e155-e160.].

Neonatal Abstinence Syndrome.

Opioid use and abuse have skyrocketed in the United States over the last decade. As a result, we have seen a substantial increase in neonates who are exposed to opioids in-utero. Anywhere from 55% to 94% of infants exposed to opioids will experience withdrawal, known as neonatal abstinence syndrome (NAS), and will require management of their symptoms in the hospital. It is important to know what to look for in an infant who is experiencing NAS, how to determine if treatment is needed and what type of treatment is indicated, and how to prepare the infant for discharge once they are stable. Unfortunately, there are no standardized care plans in place for the management of this population. Although assessment tools such as the Finnegan scoring systems are available, they are not validated and can be cumbersome and difficult to administer. Other methods of assessment are being studied and may prove to be more useful in the clinical setting of neonatal withdrawal. Neither nonpharmacologic nor pharmacologic interventions are standardized, with individual institutions determining their plan of care. Development of more standardized care could significantly improve the management of these patients. [Pediatr Ann. 2020;49(1):e3-e7.].

Substance Use in Adolescents: Latest Trends.

Adolescent substance use is an ever-changing topic that can be difficult to stay on top of its many components. Recent data show encouraging declines in the use of some substances such as cigarettes, alcohol, and opioids, although they are still prevalent in the adolescent population. Newer issues such as vaping and the legalization of marijuana bring up new challenges in discussing substance use with young patients. Perceptions of risk and evolving campaigns aimed at young people make these two topics particularly important to address with adolescents. This article reviews the statistics regarding the most commonly used substances in the United States, and some important ways that we can reach out to the adolescent population that is so vulnerable to the harms of substance use. [Pediatr Ann. 2019;48(11):e418-e422.].

Detecting Early Developmental Delays in Children.

Development is a core part of the care we provide to our pediatric patients. It should be monitored and evaluated at every visit. Whether it is performing a risk assessment, longitudinal surveillance, or a formal developmental screen, this important element of pediatric medicine is a part of every interaction that we have with our patients and their families. Identifying developmental delays early and helping families to access appropriate interventions is key to providing successful outcomes for these patients. To detect delays, we must commit to using standardized screening tools and become comfortable with their interpretation. The more opportunities we have to interact with our young patients, the more opportunities we have to assess and intervene when developmental differences are noted. This ensures the best possible outcomes for our pediatric patients. [Pediatr Ann. 2019;48(10):e381-e384.].

Immunization Considerations in Pregnancy.

Immune status during pregnancy is an important consideration, and all women who are pregnant should be screened for immunity to certain diseases. Women who are pregnant are at higher risk of contracting infections, and many infections can cause serious problems for a growing fetus. For this reason, remaining up-to-date on immunizations throughout life and especially leading up to pregnancy is important. In addition, there are certain vaccines that provide added benefit if given during pregnancy. The Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis) and inactivated influenza vaccines can provide protection not only for the pregnant mother but also for the newborn baby by passing immunity through the placenta. All pregnant women should be encouraged to receive the appropriate vaccines and be treated according to their immune status to ensure the best possible protection for this population. [Pediatr Ann. 2019;48(7):e251-e254.].

Puberty: Onset and Progression.

Puberty is an important process that providers of health care to children and adolescents should be comfortable discussing. The normal process of puberty is complex and involves many different hormonal pathways. A clear understanding of these pathways will help providers counsel patients on what to expect as they anticipate and progress through puberty as well as be alerted when puberty is not progressing normally. Both early and late puberty can have physical and psychological implications for the pediatric population. Being familiar with the common causes and initial testing of abnormal puberty will allow the primary care provider to monitor appropriately and initiate further investigation if warranted. This article reviews both the typical pubertal pathway as well as delayed and premature puberty and their common causes. [Pediatr Ann. 2019;48(4):e141-e145.].

Dental Care and Trauma Management in Children and Adolescents.

Dental health in early childhood is a predictor for oral health as we age, and oral health is an important factor affecting overall health. For this reason, providing good guidance and early intervention is imperative to help set our patients up for success. To do this, providers must be familiar with dental anatomy and development, as well as recommendations for caries prevention, pacifier use, juice consumption, fluoride, and the establishment of a dental home. Aside from general oral health care, providers must also be able to provide guidance regarding dental trauma prevention and management. As health care providers are often the first point of contact after injury, they must be able to provide acute care and appropriate referral as necessary. [Pediatr Ann. 2019;48(1):e3-e8.].

Measles in Children.

Measles, which until recently had been a rare disease in the United States, is re-emerging in our communities due to a combination of increased global mobility and decreased vaccinations across the country. As providers, we need to reacquaint ourselves with this disease so that we may diagnose it as well as educate our patients on how to prevent it. With public resistance to vaccinations on the rise, it is also important to be prepared to answer questions about the measles vaccine, its efficacy, and its side effects. By being educated ourselves, we will be able to educate our communities and help keep illnesses like measles at bay. [Pediatr Ann. 2018;47(9):e340-e344.].

Constipation Management in Pediatric Primary Care.

Constipation is a common and often difficult to manage problem encountered in outpatient primary care. Although we give our patients many different modalities to treat constipation (eg, diet changes, behavior modification, probiotics, medication), there is little evidence to support any of these modalities. We also tend to order unnecessary tests during the diagnostic process. This article tries to clarify the diagnostic process and provide a clear treatment path to be used for functional constipation. [Pediatr Ann. 2018;47(5):e180-e184.].