Caring for screenagers (part 2): a pediatrician's primer on popular games and educational tools.

PURPOSE OF REVIEW: The internet has changed the way children can work and play. With the preferences of the youth population constantly evolving, it is important that parents and pediatricians continue to be informed of the ways children spend their time on the internet. Online gaming continues to soar in popularity, as does school usage of educational platforms. RECENT FINDINGS: Roblox, Fortnite, and Minecraft are three examples of games that have widespread popularity among youth populations. Though none of the game are designed to display graphic violence, sexual content, or other features that could be considered off-limits for children, there still ways for children to exposed to inappropriate material or engage with strangers. The rise in popularity of eSports also reflects changing attitudes about the value of gaming. On the educational side, school-student platforms and powerful artificial intelligence (AI) tools are becoming more and more prevalent. SUMMARY: Parents should not simply know which games or educational tools their children are using, but understand them. This article seeks to provide some insight into popular games and platforms so that parents and pediatricians can make better decisions about what children access.

Caring for screenagers (Part 1): a pediatrician's primer on popular social media platforms.

PURPOSE OF REVIEW: Since the inception of social media, children have used platforms in manners unbeknownst to their parents. Just when parents feel they may finally understand what platform is relevant or trend is "in," the landscape evolves, and children shift to something new. It is therefore critical that pediatricians stay informed about what is popular in youth populations. This enables the recognition of the potential dangers of contemporary social media engagement. RECENT FINDINGS: Short-form content and livestreaming continue to rise in popularity while certain older forms of social media have retained relevancy in youth circles. YouTube is the dominant social media force, with both livestreaming and short-form offerings. Twitch and TikTok provide alternatives to YouTube for livestreaming and short-form content, respectively. Instagram and Snapchat - two social media apps that have existed for over 10 years - remain as the most popular mechanisms for children to interact with their friends online. SUMMARY: Issues related to body image, attention deficits, cyberbullying, and other potential harms have many parents wary of their child's presence on social media. Social media sites have in-place mechanisms to prevent the likelihood of harm, but pediatricians and parents should still counsel children on best social media practices.

Quick nic: novel smokeless nicotine products and pediatric trends.

PURPOSE OF REVIEW: The development and marketing of smokeless nicotine products in recent years have become increasingly popular among adolescents. In addition to well known conventional inhaled nicotine products, noninhaled products, such as nicotine toothpicks, orbs, lozenges, strips, and more, have dangerously captivated a new youth audience. Although smokeless nicotine products may seem to be less threatening than conventional inhaled nicotine products, there are significant risks associated with the use of these products, including addiction and severe health issues. The purpose of this review is to provide up-to-date information about alternative nicotine products currently on the market that may appeal to youth, and the dangers of nicotine use for pediatric populations. RECENT FINDINGS: Smokeless nicotine products appeal to minors with their varying flavors and discrete packaging. These products may lead to nicotine toxicity as well as severe health problems, such as cancer, issues with reproduction, and heart attacks. Nicotine is extremely dangerous for young children; in fact, using nicotine products before the age of 18 years can lead to addiction and is linked to an increased likelihood of experimenting with stronger nicotine products or illicit drugs. The development of inconspicuous nicotine packaging has led to increasing concerns for accidental nicotine exposure and overdose in youth. SUMMARY: Greater knowledge regarding current nicotine products on the market, specifically smokeless nicotine products, will help clinicians be more aware of the dangers associated with these products. Clinicians will be better able to provide their patients and families with proper guidance to avoid nicotine addiction, further drug use, and detrimental health issues. Caregivers and medical professionals must recognize novel and inconspicuous nicotine products commonly used among youth, understand the signs of nicotine abuse and dependence, and take measures to address possible nicotine-related health risks.

Paediatric cardiologist adherence to American Heart Association neurodevelopmental recommendations for CHD patients.

A 2012 American Heart Association statement concluded that children with CHD are at an increased risk for neurodevelopmental delays. Routine surveillance and evaluation throughout childhood are recommended. To assess paediatric cardiologist compliance with American Heart Association guidelines and developmental referral practices, a survey was distributed to paediatric cardiologists nationwide (n = 129). The majority of participants (69%) stated they were somewhat familiar or not familiar with the American Heart Association statement and were concerned about patients not being properly referred to specialists for developmental evaluation. Forty paediatric cardiologists (31%) indicated that their institution did not have a neurodevelopmental cardiology programme. Of these, 25% indicated they generally did not refer CHD patients for neurodevelopmental evaluation, 45% performed surveillance and referred if warranted, and 30% generally referred all patients for surveillance. Lastly, 43% of paediatric cardiologists did not feel responsible for developmental surveillance, and 11% did not feel responsible for referrals. To ensure all children with CHD are appropriately screened and referred, paediatricians and cardiologists must work together to address differing impressions of accountability for surveillance and screening of children with CHD.

Edible marijuana products and potential risks for pediatric populations.

PURPOSE OF REVIEW: In recent years, an increasing number of states have legalized marijuana, also known as cannabis, for recreational use. As marijuana becomes more accessible, adolescent use and accidental pediatric exposures are likely to become broad public health concerns. Edible marijuana products, which are consumable foods or beverages that contain cannabis extract, are particularly enticing to youth, as they come in appealing forms such as candies, cookies, and drinks. The purpose of this review is to provide pediatricians with an overview of the different types and potential dangers associated with edible marijuana products. RECENT FINDINGS: Edible marijuana products are often indistinguishable in appearance from normal food items and lack the smell and visible smoke associated with inhaled marijuana. Because they are inconspicuous, palatable, and easily accessible, they are increasingly popular among adolescents. Additionally, the packaging of edible baked goods, candies, and drinks is often purposefully very similar to that of mainstream foods, increasing the risk of accidental ingestion by children. An edible marijuana product must be digested before Δ9-tetrahydrocannabinol can enter the bloodstream, so there is a delayed onset of effects when consuming edibles compared with inhaling marijuana. This also predisposes users to accidental overconsumption. SUMMARY: Greater knowledge of edible marijuana product consumption by pediatric populations will allow pediatricians to more effectively help patients and advise caregivers in cases of overconsumption, dependence, or accidental ingestion. It is important for parents, guardians, and educators to be able to successfully identify edible marijuana products and recognize signs of cannabis use.

Puff bars: a dangerous trend in adolescent disposable e-cigarette use.

PURPOSE OF REVIEW: Puff Bars, a brand of disposable e-cigarettes, have skyrocketed in popularity recently, presenting significant health and safety risks to adolescents. Puff Bars and other disposable e-cigarette products are attractive to children and teenagers because of their vibrant colors and flavors, low cost, and ease of access. This review examines the rise in Puff Bar popularity, describes notable health and safety concerns, and provides advice for parents and pediatricians in identifying and preventing adolescent Puff Bar use. RECENT FINDINGS: Puff Bars have increased in popularity as their product design evaded strict regulations imposed on alternate e-cigarette products, such as Juul. In addition, Puff Bars' sweet and fruit flavors and marketing on social media have made their use pervasive among youth. Puff Bar use can lead to increased risk of e-cigarette product use-associated lung injury (EVALI) and potential exposure to carcinogens. Furthermore, the developmental risks of nicotine use during adolescence include negative effects on cognitive function and detriments to short-term memory. SUMMARY: Puff Bars present a significant danger to adolescents, and it is imperative that parents and pediatricians are aware of the health risks involved with vaping. Pediatricians should explore e-cigarette use during patient visits, and parents must communicate these dangers to their children and be able to identify these products to regulate their use.

Pediatric strength training: benefits, concerns, and current trends.

PURPOSE OF REVIEW: With the advent of social media combined with several large-scale promotions by nationwide gym chains, pediatric interest in strength training has reached new heights during the past few years. While this is a healthy way for young gym users to build strength and stay active, there are significant risks associated with improper utilization of exercise resources. Lack of adult supervision and guidance in the gym can lead to physical injury, inappropriate use of supplements, and body image issues. The purpose of this review is to provide pediatricians with up-to-date information about well tolerated exercise practices for pubertal and prepubertal youth. RECENT FINDINGS: Current exercise trends may negatively impact both the physical and mental health of participants. Various physical injuries may occur when adolescents use gym equipment incorrectly under inadequate adult supervision. Use of unproven equipment such as waist trainers may cause bodily injury, and social media content on exercising and weight loss can negatively influence adolescent body image. Potential consequences include low self-esteem and uncommon body dysmorphic disorders, such as muscle dysmorphia. Further, the intense marketing of supplements can induce pediatric gym users to engage in inappropriate consumption behaviors. The increasing accessibility of commercial gyms to youth has increased the potential for children and adolescents to be exposed to such physical and mental health hazards. SUMMARY: Greater knowledge regarding strength training techniques will help pediatricians guide their patients toward well tolerated and healthy gym habits. Caregivers and medical professionals should recognize the necessity of supervision, as well as the dangers of incorrect equipment use and unsafe trends to mitigate risks and maximize benefits of pediatric gym use.

The gut microbiome: an overview of current trends and risks for paediatric populations.

PURPOSE OF REVIEW: Gut health is an increasingly popular topic of discussion among scientists and the general population alike. As interest surrounding the gut microbiome grows, the accessibility to misinformation and unfounded gut health trends to youth is likely to emerge as a public health concern. The purpose of this review is to provide paediatricians with current information about the gut microbiome, as well as explanations and possible risks of the multitude of gut health trends that adolescents may be exposed to. RECENT FINDINGS: The gut microbiome is implicated in overall health by playing roles in digestion, immunity and mental health. Novel microbiome-related therapies, such as faecal microbiota transplants, and the gut-brain link show the therapeutic potential of the gut microbiome. However, unproven dietary fads and trends on social media are rampant as well, such as ginger juice shots. In addition, paediatric supplements meant to target gut health are unregulated, yet are highly marketed. Improperly applying these trends and diets may result in risks of malnutrition and body image issues for impressionable children. SUMMARY: Increased familiarity regarding the types of gut health trends and diets among young people will allow paediatricians to more effectively advise their patients about potential risks and good gut health practices. Paediatricians and caregivers serve as role models and educators with regard to children's perceptions and management of their gut and overall health.

TikTok, Tide Pods and Tiger King: health implications of trends taking over pediatric populations.

PURPOSE OF REVIEW: With children and adolescents constantly connected to their devices in an ever-changing technological landscape, new and emerging trends in entertainment media have created potential health implications for pediatric patients. The purpose of this review is to provide pediatricians with explanations of specific trends on streaming services, the popular new mobile application TikTok, recent widespread 'Internet Challenges' that include pediatric participants, and new technologies. These emerging trends can pose potential harms to the health and wellbeing of children and adolescents. RECENT FINDINGS: Recent reports and news articles have discussed popular technological trends and the adverse effects that can occur. Although technology provides access to information and social connection for youth, it also creates platforms where children can be exposed to disturbing content, peer pressure, cyberbullying, and encouragement to participate in activities that could cause potential physical harm or even death. SUMMARY: Pediatricians need to be aware of trends to best understand the implications of these technologies, especially in clinical practice. Pediatricians play an important role in educating parents and patients about the risks of these trends, in facilitating conversations about related topics including self-esteem, cyberbullying and peer pressure to promote healthy internet use, and providing necessary resources.

Alternative diets among adolescents: facts or fads?

PURPOSE OF REVIEW: With rising rates of chronic noninfectious diseases across the United States thought to be associated with the average American diet, many have adopted alternative diets. Most of these diets promise weight reduction via adherence to strict dietary guidelines, often removing certain types of food. With access to a plethora of information online, it is easy for adolescents to become confused when making dietary decisions. Although these diets promise benefits, it is important to understand common shortcomings and how to overcome them for safe implementation among adolescents. RECENT FINDINGS: This review discusses the theory, implementation, and risks associated with intermittent fasting as well as vegetarian, vegan, ketogenic, Atkins, Paleolithic, and Mediterranean diets. These considerations are further modified for pediatric populations with a focus on the social influences on dieting. SUMMARY: Although these diets may be promising, successful adherence to them requires addressing possible shortcomings associated with a certain diet. Pediatricians should be aware of how these dietary strategies may be properly implemented in order to prevent any harm to the patient. Empowering the patient and their families through informational resources is recommended. Pediatricians should also discuss motivations underlying their patient's dietary changes in order to determine whether these motivations are healthy.

Digital sextortion: Internet predators and pediatric interventions.

PURPOSE OF REVIEW: Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents. RECENT FINDINGS: Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators. SUMMARY: Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.

The cannabidiol conundrum: potential benefits and risks of cannabidiol products for children.

PURPOSE OF REVIEW: Since the federal ban on hemp products was lifted in December 2018, cannabidiol (CBD), a nonpsychoactive cannabinoid derived from hemp, has become increasingly popular and accessible. CBD is sold in the form of oils, tablets, and foods in locations including gas stations, cafés, and drug stores. Despite a lack of reliable evidence, many parents praise its purported therapeutic effects on a variety of childhood ailments. RECENT FINDINGS: Epidiolex was the first CBD-based medication to be approved by the US Food and Drug Administration in 2018 for the treatment of two rare and severe forms of epilepsy, known as Lennox-Gastaut and Dravet syndrome, in patients of at least 2 years of age. Its efficacy was assessed through three randomized, double blind, and placebo-controlled trials in a sample of 516 patients with either Lennox-Gastaut syndrome or Dravet syndrome. Despite this development, there are few or no large-scale, rigorous studies concerning the effects of CBD on any other pediatric conditions that parents have tried to alleviate with CBD. The purpose of this review is to explore recent literature regarding the efficacy and safety of CBD in treating various health conditions in children; the risks of consuming CBD products, and the role of pediatricians in helping parents navigate often-confusing information about CBD. SUMMARY: Although CBD use has dramatically increased in recent years, both its potential to treat conditions and its risks have not yet been subjected to rigorous study. Pediatricians should be aware of the risks posed by poor-quality standards and labeling practices for cannabinoid products. Due to the confusing nature of the numerous sources of information about CBD, pediatricians are in a position to provide and clarify information about CBD to parents and understand the risks it poses to children.

New age technology and social media: adolescent psychosocial implications and the need for protective measures.

PURPOSE OF REVIEW: In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development. It discusses ways that clinicians and parents can effectively safeguard their children from the potential threats posed by digital media while providing a fact sheet for parents that addresses these concerns and summarizes recommended strategies to combat them. RECENT FINDINGS: While social media platforms continue to experience surges in popularity, mounting evidence suggests significant correlations between their usage and adolescent mental health and behavioral issues. Increased social media usage has been linked to diminished self-esteem and body satisfaction, elevated risk of cyber-bullying, heightened exposure to pornographic material, and risky sexual behaviors. SUMMARY: Given how new age technology is steadily permeating everyday life, greater efforts are needed to inform adolescent users and their families about the negative consequences of social media usage. Pediatricians and parents must take cautionary measures to reduce psychosocial risks and ensure the online safety of children.

Variation in Neonate Swaddling Techniques.

BACKGROUND: It is common practice for healthcare practitioners to swaddle infants in newborn nursery and neonatal intensive care unit settings. Despite the widespread use of this practice, the American Academy of Pediatrics neither bans nor recommends swaddling. To date, there has been no standard protocol developed for either healthcare professionals or parents to establish optimal swaddling techniques in terms of infant arm positioning, infant leg positioning, and tightness of wrap. PURPOSE: To evaluate the variability in swaddling techniques used for infants in the newborn nursery and neonatal intensive care unit. METHODS: Across 2 pediatric hospitals, the swaddling positioning of each open-crib infant in the newborn nursery and neonatal intensive care unit was examined. For each infant, the following data were collected: gender, left and right arm position, left and right leg position, and tightness of wrap. RESULTS: In total, 132 swaddle observations were recorded. There was significant variability in swaddling positioning of arms and legs. The most common combination of arm/leg positioning was "mixed arm positioning" and "both legs flexed" (25.0% of all observations). In 9.1% of cases, tightness of wrap around chest was "tight," and in 30.3% of cases, tightness of wrap around legs was "tight." IMPLICATIONS FOR PRACTICE: There was a large variability in swaddling positioning of both arms and legs. For such a widespread practice, the lack of medical guidelines results in inconsistent, and potentially harmful, positioning. Parents and healthcare professionals would benefit from specific, research-driven guidelines regarding proper swaddling techniques. IMPLICATIONS FOR RESEARCH: Different variations on swaddling should be evaluated for consideration of best practice swaddling.

Fidget spinners: Purported benefits, adverse effects and accepted alternatives.

PURPOSE OF REVIEW: In the span of a few months, fidget spinners have caught the eyes of millions of children, parents, educators and paediatricians. Fidget spinners, hand-held toys designed to spin freely in your grasp, have become a source of entertainment for consumers of all ages. Despite a lack of scientific evidence, toy marketers have advertised the benefits of fidget spinners for children with attention-deficit/hyperactivity disorder and other disorders (e.g. autism, anxiety, sensory issues). Parents are incentivized by these purported benefits to purchase fidget spinners to improve their child's concentration and decrease stress. RECENT FINDINGS: While fidget spinners are a new phenomenon, existing therapy toys (e.g. sensory putty) have been used by occupational therapists for similar reasons, with comparably little research supporting these claims. The purpose of this review is to explore literature regarding sensory toys and examine educator/professional-reported concerns and medical adverse effects of using fidget spinners. SUMMARY: Due to a recent surge in popularity, fidget spinners and other self-regulatory occupational therapy toys have yet to be subjected to rigorous scientific research. Thus, their alleged benefits remain scientifically unfounded. Paediatricians should be aware of potential choking hazards with this new fad, and inform parents that peer-reviewed studies do not support the beneficial claims.

Parental Perception of Risk Associated With Their Premature Infant.

BACKGROUND: Preterm birth has been linked to increased parental stress, depression, and anxiety. Although the rate of neonatal morbidity and mortality decreases with increasing gestational age, recent research has revealed that there is no threshold age for risk or parental concern. PURPOSE: This study examines parental concern about medical and developmental outcomes of their premature infant. METHODS: Parents of 60 premature infants were surveyed in a follow-up clinic regarding their level of concern about 11 morbidities and their child's gestation-adjusted age; these were compared with the infant's inpatient chart. "Concern scores" were tallied and compared across gestational age groups and knowledge of gestation-adjusted age using Chi-square tests of independence. FINDINGS: Many parents reported concerns about morbidities that were unsupported by their child's diagnoses. Across parents of extremely, very, and moderate-late preterm children, the mean concern scores were 13.9, 15.7, and 19.7, respectively. Overall, 62% of parents incorrectly reported the gestation-adjusted age of their child. Parents who were correct were significantly more likely to correctly anticipate abnormal developmental patterns (70%) and growth patterns (65%) than those who were incorrect (33% and 31%, respectively). IMPLICATIONS FOR RESEARCH: Future research should focus on whether NICU graduate parental stress levels are directly linked to the severity of their child's condition, and how physicians can help decrease NICU graduate parental stress. IMPLICATIONS FOR PRACTICE: Parental anxiety regarding all gestational age neonatal intensive care unit infant outcomes can be decreased by a thorough explanation of gestation-adjusted age and a discussion of expected prematurity-related issues.

Health implications of new-age technologies: a systematic review.

INTRODUCTION: New-age technologies are ubiquitous in the lives of adolescents. Recent trends in media use suggest that adolescents are spending more time than ever engaging with technologies, and are able to do so in virtually all settings at any time. Given that new-age technologies are so heavily integrated within the daily life of adolescents, the health risks and benefits they offer must be closely examined. EVIDENCE ACQUISITION: In this systematic review, we present recent literature related to the implications of new-age technologies on adolescent health. A total of 94 articles published since 2006 were collected using PubMed and Google Scholar on the most popular new-age technologies among adolescents: the internet, television, cell phones, and video games. EVIDENCE SYNTHESIS: The current body of research highlights several health risks related to these technologies. Nearly all have the potential for addiction, which can result in other symptoms and impair one's daily life. Excessive use can affect several components of health, such as quality of sleep, body composition, and mental well-being, and certain practices (viewing pornography, sexting) can lead to risky sexual behaviors. However, the technologies discussed in the present review also have tremendous potential to promote adolescent health. CONCLUSIONS: Pediatricians must educate parents and patients on how to safely use technology to minimize the potentially harmful outcomes.

Long-term neurodevelopmental benefits of breastfeeding.

PURPOSE OF REVIEW: The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of an infant#$#apos;s life, with continuation of breastfeeding for at least a year or as mutually desired by mother and child. A robust body of research literature documenting the short-term medical, developmental, and emotional benefits of breastfeeding for infants and toddlers supports this position. This article reviews the neurodevelopmental benefits of breastfeeding as it relates to preschool and school-age children, with particular emphasis on cognitive development, attention-deficit/hyperactivity disorder, and autism spectrum disorder. RECENT FINDINGS: The majority of research studies examining breastfeeding and long-term neurodevelopmental outcomes suggest that children who breastfeed for longer than 6 months have better cognitive outcomes, lower risk of developing attention-deficit/hyperactivity disorder, and lower risk of being diagnosed with autism spectrum disorder. SUMMARY: Pediatricians play a critical role in educating and counseling families about infant nutrition and feeding. Along with the many positive short-term medical effects that breastfeeding confers, physicians should be aware of the growing body of research suggesting that there are also significant long-term neurodevelopmental benefits of breastfeeding.

Pokémon Go and augmented virtual reality games: a cautionary commentary for parents and pediatricians.

PURPOSE OF REVIEW: The recent release of Pokémon Go has ushered in a new set of challenges for parents and pediatricians, highlighting the importance of parents setting guidelines for video game use with their children. Within 1 week of its launch, the game attracted over 65 million users, many of whom are young children. Despite the potential benefits of the game described in our article, this location-based game format poses specific threats to the safety and physical wellbeing of children. RECENT FINDINGS: Reports have discussed both the benefits and adverse effects of this extremely popular video game. Benefits include increased exercise, socialization, and outdoor activity. Negative effects include increased risk of injury, abduction, trespassing, violence, and cost. SUMMARY: Pediatricians play a key role in counseling parents and children about safety precautions and setting appropriate limits for impressionable youth. Parents and pediatricians should be aware of this new and remarkably popular game that appeals to a wide variety of individuals. To protect children from injury, predators, and inappropriate situations, parents and pediatricians must regulate children's participation in this game and maintain vigilance for potentially dangerous circumstances.

Macro preemies: no thresholds for risks or concerns.

PURPOSE OF REVIEW: To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS: Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY: Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.