Pediatricians follow patients longitudinally and hold a unique position to address multiple issues, medical and psychosocial, that affect organ donation and transplantation. They are wellpositioned to provide anticipator...Pediatricians follow patients longitudinally and hold a unique position to address multiple issues, medical and psychosocial, that affect organ donation and transplantation. They are wellpositioned to provide anticipatory guidance during well-child visits and during care for children with end-stage organ failure and can either assist these patients with ongoing medical management or refer these patients for organ transplantation assessment. A pediatrician's trusted relationship with families and patients allows for guidance on medical and ethical issues surrounding brain death, organ donation, and transplantation. A clear understanding of end-of-life care, criteria for the determination of neurologic and circulatory death, the process of organ donation, and posttransplant management is vital for pediatricians. The American Academy of Pediatrics (AAP) recognizes and supports the important role of the pediatrician in the global need for organ donation and transplantation awareness. This article, as well as the updated AAP policy on Pediatric Organ Donation and Transplantation and the revised American Academy of Neurology consensus statement for the determination of neurologic death for children and adults, provides guidance to help shape public opinion, public policy, and care of the pediatric organ donor and the transplant recipient.
By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagno...By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through...Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acu...Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.
Pediatr Rev
· 2023 Nov · PMID 37907421
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EDUCATION GAP: Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent...EDUCATION GAP: Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent, and treat influenza cases. Disease caused by influenza virus can be mitigated with appropriate treatment and prevention efforts. OBJECTIVES AFTER COMPLETING THIS ARTICLE, READERS SHOULD BE ABLE TO:: 1. Describe the virology and epidemiology of influenza. 2. List the clinical features and complications of influenza infections. 3. List the benefits and limitations of testing modalities for the diagnosis of influenza. 4. Appropriately apply American Academy of Pediatrics, Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) treatment guidelines for influenza or suspected influenza. 5. Describe the importance of influenza vaccination.
Despite improvements in oral morbidity levels and access to care among the pediatric population, there are still major disparities in the United States. Results of national surveys have documented a decrease in the numbe...Despite improvements in oral morbidity levels and access to care among the pediatric population, there are still major disparities in the United States. Results of national surveys have documented a decrease in the number of children receiving either a dental examination or a cleaning. This finding is particularly concerning for toddlers and infants, as early preventive dental visits and the establishment of a dental home is cost-effective and leads to enhanced oral health outcomes over the life span. Many infants and toddlers do not visit a dentist, suggesting that the recommendations of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to establish a dental home are not appropriately adopted.
The American Academy of Pediatrics released a clinical practice guideline for the management of febrile infants in August 2021 to compile nearly 40 years of research into a cohesive text that would provide a framework fo...The American Academy of Pediatrics released a clinical practice guideline for the management of febrile infants in August 2021 to compile nearly 40 years of research into a cohesive text that would provide a framework for the clinician in safely managing these patients in a variety of settings. (1) This guideline incorporates shared decision-making with the caregiver to guide treatment when appropriate and provides algorithms for 3 age groups: 8 to 21 days, 22 to 28 days, and 29 to 60 days. This guideline applies to previously healthy, well-appearing infants born at 37 weeks' gestation or later who have a temperature of at least 100.4°F (≥38.0°C) in the previous 24 hours at home or in a clinical setting. Infants younger than 8 days and those with diagnosed focal infections are excluded. The highlighted changes to historical practice are in the 2 older age groups. In 22- to 28-day-old infants, if initial laboratory work is normal, shared decision-making is used to direct lumbar puncture and hospital admission with the possibility of monitoring the patient at home or in the hospital. In 29- to 60-day-old infants, admission to the hospital is indicated only if laboratory evaluation is concerning for meningitis or based on clinician judgment. The occurrence of invasive bacterial infection in a febrile infant with a positive viral test is still not well-measured, as broad viral panels are more recently developed technology. As this research evolves and expected advancements in early detection of infectious organisms and biomarkers occur, this new information will need to be incorporated into the existing evidence.
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiolo...Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
There has been an increasing focus on the impact of racism both within pediatrics and throughout society as a whole. This focus has emerged as a result of the current sociopolitical climate in the United States coupled w...There has been an increasing focus on the impact of racism both within pediatrics and throughout society as a whole. This focus has emerged as a result of the current sociopolitical climate in the United States coupled with the recent deaths of Black Americans by law enforcement and the maltreatment of Latina/o immigrants. In 2019, the American Academy of Pediatrics released the landmark policy statement "The Impact of Racism on Child and Adolescent Health," which describes the profound effects of racism on health, its function in perpetuating health disparities, and the potential role of child health professionals in addressing racism as a public health issue. (1) Foundational knowledge regarding race, racism, and their relation to health are not consistently included in standard medical education curricula. This leaves providers, including pediatricians, with varying levels of understanding regarding these concepts. This article seeks to provide an overview of the intersection of race, racism, and child/adolescent health in an effort to reduce knowledge gaps among pediatric providers with the ultimate goal of attenuating racial health disparities among children and adolescents. Please reference the Table for additional resources to reinforce concepts described throughout this article.
The published literature supports the high prevalence of supplement use in children and adolescents in the United States. Pediatricians today are faced with questions from parents and patients about the benefits, safety,...The published literature supports the high prevalence of supplement use in children and adolescents in the United States. Pediatricians today are faced with questions from parents and patients about the benefits, safety, efficacy, and correct dose of vitamins and minerals. In this article, we review 7 vitamins with the most clinical relevance as judged by abundance in food, risks and symptoms of deficiency, and potential for toxicity. Specifically, we focus on possible clinical scenarios that can be indicative of nutritional deficiency. We synthesize and summarize guidelines from nutrition experts, various medical societies, the World Health Organization, and the American Academy of Pediatrics.
Lower blood glucose values are common in the healthy neonate immediately after birth as compared to older infants, children, and adults. These transiently lower glucose values improve and reach normal ranges within hours...Lower blood glucose values are common in the healthy neonate immediately after birth as compared to older infants, children, and adults. These transiently lower glucose values improve and reach normal ranges within hours after birth. Such transitional hypoglycemia is common in the healthy newborn. A minority of neonates experience a more prolonged and severe hypoglycemia, usually associated with specific risk factors and possibly a congenital hypoglycemia syndrome. Despite the lack of a specific blood glucose value that defines hypoglycemia, concern for substantial neurologic morbidity in the neonatal population has led to the generation of guidelines by both the American Academy of Pediatrics (AAP) and the Pediatric Endocrine Society (PES). Similarities between the 2 guidelines include recognition that the transitional form of neonatal hypoglycemia likely resolves within 48 hours after birth and that hypoglycemia that persists beyond that duration may be pathologic. One major difference between the 2 sets of guidelines is the goal blood glucose value in the neonate. This article reviews transitional and pathologic hypoglycemia in the neonate and presents a framework for understanding the nuances of the AAP and PES guidelines for neonatal hypoglycemia.
After completing this article, readers should be able to: 1. Recognize the clinical presentation of bronchiolitis. 2. Be aware of the recommendations made in the current American Academy of Pediatrics clinical practice g...After completing this article, readers should be able to: 1. Recognize the clinical presentation of bronchiolitis. 2. Be aware of the recommendations made in the current American Academy of Pediatrics clinical practice guideline for diagnosis and management of bronchiolitis. 3. Describe the role of laboratory testing in the diagnosis of bronchiolitis. 4. Delineate the efficacy of current therapeutic interventions in the treatment of bronchiolitis. 5. Discuss the evaluation for serious bacterial infections in patients who have bronchiolitis. 6. Outline the prognosis and risk of recurrent wheezing in patients diagnosed with bronchiolitis.
Our inaugural story for Pediatrics in the Community was in the January 2007 edition of Pediatrics in Review. Dr Robert Haggerty provided the historical rationale for community pediatrics training (CPT) as part of that fe...Our inaugural story for Pediatrics in the Community was in the January 2007 edition of Pediatrics in Review. Dr Robert Haggerty provided the historical rationale for community pediatrics training (CPT) as part of that feature. Now, 1 year later, we asked Dr Jeff Kaczorowski, Director of the CPTI at the American Academy of Pediatrics (AAP), to describe the present and future of CPT. As the stories in this series have shown, some residents are having wonderful community experiences already and making a difference in the lives of children in their communities. The challenge is how to make such experiences available to all pediatric residents and pediatricians.-C. Andrew Aligne, MD, MPH, Section Editor.
Bukutu C, Deol J, Shamseer L
… +2 more, Vohra S, American Academy of Pediatrics Provisional Section on Complementary, Holistic, and Integrative Medicine
Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-be...Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.