Pediatric Annals

Diversity, equity, inclusion, and justice (DEIJ) are important factors to be considered in medical education, academic and community health centers, and health care policy. DEIJ efforts have been shown to have a strong influence in advancing health equity, yet these efforts tend to fall on a small group of providers, usually of historically marginalized or minority backgrounds (eg, race and ethnicity, gender identity, sexual orientation, religion). To combat this inequity, more research needs to be done to identify where the burden is falling and what strategies can be set in place to counteract this taxing imbalance...

Rates of developmental screening have increased, and understanding how to discuss delays with families is imperative. Knowledge of federal and state law regarding special education is needed. Families often need support to understand the complexity of early intervention and school district-based services. The Individuals with Disabilities Education Act is the law that mandates services for children from birth to age 21 years who require them. Early intervention provides services for children age 0 to 3 years who have a delay or a condition with a high probability of delay...

The 2023 American Academy of Pediatrics' "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (Obesity CPG)" is a comprehensive document that addresses the evaluation and treatment of pediatric obesity. Much attention has been focused on the use of medications and surgery to treat severe obesity, but the document also thoroughly reviews the evaluation of obesity and its comorbidities through key action statements and consensus recommendations. The majority of these evaluation guidelines are well within the scope of the general pediatrician and an understanding of and implementation of them can lead to improved obesity care in the primary care setting...

Human papillomavirus (HPV) vaccine is an underutilized tool in cancer prevention. HPV vaccine completion rates in adolescents age 13 to 15 years remain low at 59%. The HPV vaccine can prevent more than 90% of cases of cancer caused by HPV, including cervical, oropharyngeal, anal, penile, vulvar, and vaginal. HPV vaccine is very safe and effective, as demonstrated by numerous large-scale studies. Practice-based strategies can improve vaccination rates, such as having providers give a strong presumptive recommendation for the vaccine, using motivational interviewing for hesitant families, and using electronic health record reminders to prompt providers to offer it, among other interventions...

No abstract text is available yet for this article.

Primary care pediatric providers play an important role in the education of future medical professionals. However, it may feel challenging to integrate a learner into out-patient practice given both time constraints and varying levels of experience among learners. Here we discuss how learners at various stages of training from different medical professions can be integrated into the outpatient pediatric clinical environment. We review eight teaching strategies and provide examples of their use in practice. The goal is to introduce tools to support teachers working with learners in the clinical environment to optimize educational experiences for both teachers and learners...

Factors affecting caregiver health and wellbeing, such as trauma and stress, can have significant negative impact on parenting behaviors and on subsequent child physical and mental health. Trauma-informed positive parenting (TIPP) is an effective tool that acknowledges and addresses a family's unique journey and needs, while promoting both nurturing caregiver-child interactions and appropriate limit setting. Primary care practices are in unique positions to provide such interventions, due to their long-standing and trusted involvement with families...

No abstract text is available yet for this article.

This article focuses on the advancements made in diagnostic techniques and drug interventions of acute hematogenous osteomyelitis. A diagnosis necessitates a combination of factors, including inflammatory markers and imaging findings, as well as the collection of specimens for culture when feasible. Subsequently, treatment should be based on epidemiology, mechanisms of resistance, and susceptibility findings. A brief course of intravenous (IV) antibiotics, followed by oral antibiotics, may be employed for uncomplicated infections if there is improvement in the clinical condition and a decline in C-reactive protein levels...

There has been an overall increase in the number of suspected suicide attempts by self-poisoning among the adolescent population. Incidences of self-poisoning have increased since the coronavirus 2019 pandemic, particularly among patients age 10 to 19 years. Common agents used in self-poisoning include over-the-counter and prescription medications. It is crucial to identify adolescent patients with risk factors and provide appropriate resources to reduce the likelihood of intentional toxic ingestion. This article aims to summarize the current state of intentional toxic ingestions by adolescents, provide an overview of the most common agents implicated in self-poisoning, and discuss the best practices in screening patients...

It has long been established that the environment in which a child grows and develops shapes their social and health outcomes. After all, collecting social history is a key component of a health care visit. In recent decades, the importance of social determinants of health (SDOH) has been rediscovered, and the impact of adverse childhood experiences has garnered great attention. Estimates show that health outcomes are influenced more by factors outside of health care, such as our patients' SDOH. Addressing SDOH is fundamental for improving health and reducing longstanding inequities in health...

There are multiple reasons why pediatric hospitalists become involved in the care of surgical patients. Several are related to postoperative complications or acute medical issues that arise during their hospitalization. Comanagement programs have become increasingly utilized in the care of such patients, providing a different model of collaboration between hospital medicine and surgical providers. Traditionally, pediatric hospital medicine providers were consulted only when acute needs were identified. There has been much added value seen in the use of comanagement models, especially given the increased complexity of pediatric surgical patients and the development of pediatric hospital medicine as a subspecialty...

Pediatric procedural sedation (PPS), formerly known as conscious sedation, is often used outside the operating room for various procedures. Twenty years ago, nearly all cases of PPS were performed by pediatric intensivists, dentists, emergency medicine physicians, and anesthesiologists, due to the urgent nature of procedures in their settings. However, with the emergence of pediatric hospital medicine as a board-certified subspecialty, many children's hospitals have created dedicated PPS teams. These teams, composed of highly trained physicians and ancillary staff, are well-suited for procedures, quality measures, and multidisciplinary care...

No abstract text is available yet for this article.

New American Academy of Pediatrics (AAP) guidelines were published in 2021 for the evaluation and management of well-appearing febrile infants from age 8 to 60 days. This first guideline of its kind from the AAP brings together increasing evidence from the last 20 years and replaces the varied protocols previously used (eg, Rochester, Philadelphia, Boston). The guideline also incorporates lessons from newer studies, such as the work of the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network...

No abstract text is available yet for this article.

Measles is a viral illness considered eliminated in the United States; however, outbreaks still occur even in this modern era where vaccines are readily available for every child under government-sponsored financing programs. The most recent measles outbreak was reported in March 2024 in Chicago, Illinois. Many of these patients were children younger than age 5 years with unvaccinated or unknown vaccine status, and this outbreak was associated with a migrant shelter. Measles bears a resemblance to other exanthemic diseases of childhood...

No abstract text is available yet for this article.

Eating disorders affect individuals of all ages, genders, sexual orientations, ethnicities, races, and socioeconomic statuses. They can lead to serious medical complications that require inpatient treatment. The eating disorders that are most likely to lead to medical complications requiring medical inpatient stabilization include anorexia nervosa, atypical anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa, and purging disorder. There are criteria that can help determine if a patient requires inpatient stabilization...

Body mass index (BMI) is a tool that is commonly used to screen for obesity. There are advantages and limitations of the use of BMI in the pediatric population. It is an inexpensive and easily implemented tool that can provide insight for clinicians, patients, and caregivers. It may help guide the discussion of the potential health impacts of weight, although there are both practical and philosophical limitations to its use. Clinicians should be aware of the nuances of the use of BMI in practice. This article covers a brief history of the BMI, how it is used in pediatrics, its advantages and limitations, as well as strategies for using BMI to facilitate discussions with patients and families...