Current opinion in pediatrics最新文献

Purpose of review: Nonaccidental trauma remains a significant and underrecognized contributor to pediatric injury and mortality, reflecting both clinical and societal challenges in prevention and early identification. This review aims to synthesize the most recent literature on pediatric nonaccidental trauma (NAT) to better equip members of the healthcare team, particularly those in direct patient care, such as physicians, with the insight, contextual awareness, and ethical vigilance needed to identify, manage, and intervene in cases of child maltreatment. In doing so, it highlights the critical role of the healthcare team in not only treating injury but also protecting vulnerable children and addressing the broader implications of abuse.

Recent findings: Recent literature highlights specific types of cutaneous injury, including patterned bruising and scald burns as well as high-energy osseous fractures such as those involving the femur, skull, face, ribs, or sternum, particularly when accompanied by an incongruent history, as the strongest indicators of NAT.

Summary: Nonaccidental trauma is often difficult to identify on both historical and clinical levels. Guardians, typically the abusers, may be evasive and may offer accounts that are inconsistent or incompatible with the presenting injury. Identifying nonaccidental trauma calls for heightened vigilance and a high index of suspicion in providers, as their proximal position affords them the responsibility to be a crucial lifeline.

Purpose of review: Children with disabilities face inequities in accessing timely special education services, often reinforced by fragmented healthcare and educational systems. Pediatric practices play a critical role in addressing social determinants of health (SDOH) by integrating educational navigation into routine care.

Recent findings: Education is consistently identified as a major social determinant of health, shaping long-term outcomes in literacy, employment, and health equity. Recent studies highlight that gaps in provider training and fragmented systems delay evaluations and interventions. Programs such as the EASE Clinic demonstrate that embedding advocacy within pediatric settings improves coordination, strengthens family engagement, and reduces inequities for marginalized communities.

Summary: Integrating special education advocacy into clinical care transforms pediatrics into a platform for upstream intervention. The EASE Clinic model supports provider training, aligns healthcare with federal educational protections, and reduces disparities in access. Replication across pediatric systems can improve developmental outcomes and establish educational equity as a foundation of child health, offering a scalable public health model that aligns medical care with educational justice.

Purpose of review: To examine the landscape of place-based initiatives seeking to improve child health and address health inequities within a defined geography, and to evaluate recent literature to develop strategies to center housing-focused interventions at the center of such initiatives.

Recent findings: The evidence showed that place-based efforts vary by primary focus, geographic scale, target populations, and types of interventions. Multipronged, multisector collaborative efforts aimed at improving population health outcomes have the most potential to advance pediatric health across neighborhoods and reduce disparities. Yet, few place-based models integrate housing as a central intervention, though there are some notable exceptions. Evidence suggests that place-based initiatives must expand housing interventions across four domains: ensuring affordability, preventing instability, prioritizing quality, and investing in neighborhoods. Intentional efforts to minimize risk of displacement and prevent widening disparities are critical. Ensuring the success of this work will require innovating in leadership structure, sustainable funding models, rigorous evaluation, and enhanced dissemination of results.

Summary: To realize the full potential of place-based interventions, housing must be the cornerstone. Integrating affordable, stable, quality housing into these initiatives can drive population-level improvements and reduce racial disparities in health outcomes.

Purpose of review: The Coleman block test is a key component of the foot and ankle physical examination in children and adults. This review describes the Coleman block test and summarizes its implications in surgical decision making as well as its limitations.

Recent findings: The Coleman block test is a classic technique for evaluating whether the hindfoot deformity in a cavovarus foot is flexible or rigid. It involves placing a wooden block underneath the lateral column of the foot to remove the effect of the plantarflexed first ray of the cavus deformity and assessing whether the hindfoot varus subsequently corrects into valgus. When the hindfoot is flexible, only the cavus requires surgical correction. However, if the hindfoot varus is rigid, additional correction is needed, typically a lateral displacement osteotomy of the posterior calcaneus. More recent modifications to the test include radiographic evaluation of the foot while on the block, and a modification for block placement that is particularly useful in children.

Summary: The Coleman block test is a simple clinical test should be performed routinely when assessing cavovarus deformities to help devise the most appropriate surgical plan.

Purpose of review: Mobile healthcare is an innovative solution to address barriers to postpartum and infant visits among underserved communities. The purpose of this review is to describe how mobile postpartum care can improve the health and well being of birthing people and their infants.

Recent findings: Many mobile healthcare programs for postpartum dyads exist, but few are discussed in the literature. Key themes of existing programs are a focus on meeting patients in their communities, providing care to the birthing person and infant in a single encounter and setting, advanced practice nursing leadership and staffing, and screening for health-related social needs.

Summary: Mobile healthcare is an innovative solution to reduce barriers to postpartum care, given the intrinsic relationship between the health and well being of birthing persons and their infants.

Purpose of review: Scoliosis and limb length discrepancy (LLD) are frequent findings in pediatric orthopedic practice. Because both conditions can alter posture and spinal alignment, distinguishing between a compensatory spinal curvature due to LLD and a true structural scoliosis is crucial. This review explores the relationship between scoliosis and LLD in children, emphasizing recent evidence and clinical strategies for accurate diagnosis and management.

Recent findings: Minor limb length discrepancies are common in the general population. However, significant LLD (defined as >2 cm) can produce pelvic tilt and a functional scoliosis, which typically resolve when the LLD is corrected. Even smaller discrepancies (<2 cm) may contribute to spinal curvature in growing children, and correcting these differences may reduce the Cobb angle of a functional scoliosis. Additionally, after surgical correction of structural scoliosis, compensatory LLD often improves, reflecting the complex biomechanical relationship between the spine and lower limbs.

Summary: LLD and scoliosis can mimic or exacerbate one another, making careful evaluation essential in pediatric patients. True structural scoliosis must be differentiated from a functional scoliosis secondary to LLD. An accurate assessment of leg lengths should be part of the routine evaluation for any child with scoliosis. When a significant LLD is identified as the cause of spinal curvature, appropriate treatment, such as shoe lifts or surgical correction of the limb inequality, might correct the spinal curvature in the coronal plane. In contrast, in idiopathic scoliosis with a minor coexisting LLD, treatment should primarily address the spinal deformity.

Purpose of review: Pediatric bone sarcomas - principally osteosarcoma (OS) and Ewing sarcoma (ES) - remain curable for many with localized disease, but outcomes for metastatic or relapsed cases have stagnated. We synthesize recent clinically relevant developments that inform diagnosis, risk stratification, local control, systemic therapy, and survivorship in children and adolescents.

Recent findings: Standard frontline therapy has not changed in decades for OS and ES. Maturing evidence for new technologies such as circulating tumor DNA (ctDNA) raises questions of how to validate and incorporate these tools into treatment regimens to improve outcomes for children with bone sarcomas. In OS, the debate between a minimally invasive approach to pulmonary metastasectomy over open thoracotomy remains; attempts to address this debate are underway. Improving survival continues to pose a great challenge. Adding tyrosine kinase inhibition to chemotherapy is the current strategy to improve upfront therapy, while a more radical approach of frequently changing drug combinations in the upfront setting, in an attempt to evade resistance, is also being tested in OS and ES. While the rEEcur trial attempted to compare chemotherapeutic regimens for relapsed ES, better understanding of the underlying biological nature of OS and ES are necessary for development of novel treatment strategies. Long-term survivorship care remains a global focus for various national consortia.

Summary: Although the activity of single-agent checkpoint inhibitors remains disappointing in pediatric bone tumors, rational tyrosine kinase inhibitor-chemotherapy combinations, improved biologic risk stratification (ctDNA; MYC in OS; STAG2 in ES), recycling chemotherapeutic agents, and standardized local-control frameworks are being developed to reshape care. Near-term priorities include biomarker-anchored upfront trials and supportive-care measures that preserve cure while reducing late effects. Clinical trials provide access to potentially paradigm-shifting therapeutic strategies.

Purpose of review: The Food as Medicine (FAM) movement has gained momentum as a strategy to address food insecurity and manage diet-related chronic conditions by integrating food prescriptions, medically tailored meals, and culinary and nutrition education into clinical care. However, few FAM programs have evaluated long-term sustainability, equity outcomes, or structural impact on systems-level change beyond food insecurity in the hospital setting alone. This case study reviews feasible, equity-centered evaluation strategies leveraged by the Nourishing Our Community Program (NoC) at Boston Medical Center (BMC), one of the country's oldest and most comprehensive health system-based FAM initiatives.

Recent findings: We trace the historical development of NoC, highlighting key adaptations in evaluation strategy and outlining embedded data collection methods across clinical and community settings. The evaluation approach captures both traditional metrics (e.g., food insecurity screening outcomes) and broader measures, including patient experience, cultural relevance, and local economic impact.

Summary: By embedding equity into every stage of program design and assessment, this case study provides a replicable framework for health systems aiming to sustain and scale food-based interventions. It also contributes to the limited but growing body of literature on systems-level implementation of FAM programs that address both individual health outcomes and structural drivers of inequity.

Purpose of review: Strong evidence shows that early childhood education (ECE) impacts child health and wellbeing throughout the life course. Contextual factors including the rising cost of ECE and the strain of the COVID-19 pandemic on childcare arrangements have ignited national conversations about ECE. We build on existing evidence to propose a conceptual model that demonstrates mechanisms of multilevel health impacts.

Recent findings: There is increasing recognition that ECE influences health beyond the level of the child to impact health at the levels of parent/family and community. Innovations in medical and ECE settings and cross-sector efforts can improve multilevel health outcomes by leveraging the healthcare platform to improve access to ECE, integrating mental health supports into ECE settings, and facilitating communication and data sharing between the two systems.

Summary: We integrate insights from multiple early childhood disciplines, including psychology, education, and medicine to propose a model for the impacts of ECE on multilevel health outcomes. This model highlights the importance of cross-disciplinary approaches to realize the full health benefits of ECE and can inform future research and advocacy. We highlight the need for pediatricians to work across early childhood disciplines to achieve greater impact on comprehensive wellbeing.

Purpose of review: Mothers in the United States are unwell, with high rates of maternal stress and death. Maternal health matters in its own right, and it is more difficult for children to be well if their parents are not. Improving mothers' economic status and social connectedness to improve maternal and child health has received increased attention.

Recent findings: New data build on previous findings that economic (e.g., financial strain, lost health insurance) and social [e.g., adverse childhood experiences (ACEs), structural racism] stressors are associated with poorer maternal and child health. Conversely, economic and social supports (e.g., cash transfers, paid family and medical leave, social connectedness) improve aspects of maternal and child health. Evidence on whether pandemic-era cash transfers impact maternal and child health is mixed.

Summary: Addressing social and economic stressors can improve maternal and child health, but the details matter. Incremental economic interventions are insufficient. Social factors such as isolation and structural racism must also be addressed. Policy implementation is equally important; families cannot benefit if they cannot access resources. Policy changes such as universal paid family and medical leave are needed. The field of pediatrics should update practice guidelines and advocate for policy changes.