Current opinion in pediatrics最新文献

Purpose of review: Throughout history, competitive sport has been categorized by sex. Since the 1930s, sporting organizations have implemented various methods of confirming sex for competition in the female category. These policies primarily impact individuals with differences of sex development (DSD), whose biology falls outside the binary of male/female, and individuals who identify as transgender, whose identity differs from their sex at birth. This review will cover the dimensions of biologic sex, the history of sex verification in sport, the role of testosterone, and review data for athletes who have DSD or are transgender.

Recent findings: Several recent studies, reviews, and policy statements demonstrate that testosterone and its rise during masculinizing puberty are key determinants of differences in athletic performance between men and women. Recent studies in adult transgender women who went through a masculinizing puberty show that after 2 years of estradiol and antiandrogen therapy, run times are similar to cisgender women, but they still retrain strength advantages. Data are sparse for individuals who had masculinizing puberty blocked and also for individuals who have a DSD.

Summary: Sex is complex and multidimensional, and there are shortcomings with any method of sex verification in sport. Testosterone remains a key determinant of differences in athletic performance by sex.

Purpose of review: Recent trends show an increase in the prevalence and incidence of type 2 diabetes and prediabetes among youth, adolescents, and young adults (AYA) in the United States, especially among minoritized groups, including American Indians and African Americans. Despite the growing urgency of addressing rising incidence, there is a notable lack of comprehensive intervention programs tailored to address the unique needs of AYA living with or at risk of diabetes, with current efforts largely focused on adult/older populations.

Recent findings: This review highlights the large gap in research regarding the implementation and efficacy of behavioral and lifestyle interventions targeting AYA with type 2 diabetes or prediabetes. Although we identified some studies that were relevant to this largely under-researched area, these studies are often limited by lack of long-term follow-up and highly selected samples lacking diversity.

Summary: The findings of this review underscore the need for more extensive studies on AYA-focused behavioral interventions to address diabetes prevention and management.

Purpose of review: This review highlights recent genetic discoveries and therapeutic advancements in evaluating and managing children with short stature. With an increasing diagnostic yield from genetic testing and the emergence of genotype-specific treatments, a comprehensive update is necessary for timely application in clinical practice.

Recent findings: New pathogenic variants have been identified in genes, including FBN1, IHH, NPR2, ACAN, FGFR3, COMP, MATN3, EXT2, and LZTR1, associated with syndromic and nonsyndromic short stature. Their clinical significance is underscored by sequencing studies showing a diagnostic yield of up to 33% in idiopathic short stature. Concurrently, targeted pharmacologic agents, such as vosoritide or infigratinib, are advanced treatment options for genetically defined achondroplasia. In addition, more data is available on growth hormone responses in children with various genetic short statures.

Summary: Incorporating genetic testing into the routine investigation of short stature improves diagnostic accuracy, enables early discussion of prognostic outcomes, and facilitates precision therapy. Timely identification of specific gene variants helps avoid ineffective treatments - such as growth hormone in resistant genotypes - and supports the adoption of personalized medicine interventions.

Purpose of review: In recent years, there have been increased discussions among parents about the use of Complementary and Alternative Medicine for kids, specifically dietary supplements and vitamins. While these were originally marketed to supplement nutrient needs, many families have begun to raise questions about the efficacy of vitamins and minerals to treat developmental conditions such as attention-hyperactivity deficit disorder, mood disorders, or sleep disturbances.

Recent findings: Research investigating the use of vitamin supplements generally concludes that supplementation may be necessary in cases of deficiency; additional benefits are minimal. Some hormonal and mineral supplements like melatonin, fish oil, and magnesium have been found to reduce symptoms of hyperactivity, sleep disturbance, and conduct disorders in combination with other interventions. However, none of these therapies rival the efficacy of first-line treatment plans for these conditions. Additionally, overuse may lead to toxicity and adverse effects.

Summary: While many parents may have concerns about their child's nutrient intake, much is still unknown about the dosing, safety, and efficacy of dietary supplements. For deficient children or patients resistant to eating certain food groups, mineral and vitamin supplements may be an effective way to meet nutritional needs. It is important to note that there is little evidence supporting the efficacy of dietary supplement use to treat other conditions nor any benefit for healthy children with a balanced diet.

Purpose of review: We provide an overview of the secular trend of earlier pubertal development, why there is a growing concern that environmental factors may be to blame, and how these factors may influence the developing reproductive axis.

Recent findings: We highlight recent work suggesting that, in addition to activating sex steroid receptors, environmental compounds may influence neuropeptide receptors and/or epigenetic regulators. We describe recent studies linking air pollution, metals, endocrine disrupting compounds (EDCs), short sleep duration, early life adversity, and stress to pubertal timing.

Summary: Pubertal timing is tightly controlled by genetic, epigenetic, and environmental factors. While animal and epidemiological studies have pointed to several potential environmental factors, additional work is necessary to identify the critical levels and developmental windows of exposure as well as the mechanistic underpinnings.

Purpose of review: Intrauterine devices (IUDs) are safe and effective for most adolescents and young adults (AYA) for both contraception and menstrual management. However, multiple barriers exist to placement, including procedure-associated pain. There has been a recent call to action for healthcare providers to optimize pain management strategies for IUD insertion.

Recent findings: Approach to pain management for IUD insertion varies significantly among providers, and there is no standardized approach to comfort optimization. Several methods of pain control for IUD insertion, both pharmacologic and nonpharmacologic, have been studied, though many have variable results.

Summary: Approaching IUD insertion counseling through a lens of patient autonomy and reproductive justice will likely improve the patient experience and help providers to work toward enhancing comfort during the procedure. Further research is needed to determine optimal pain control strategies for IUD insertion.

Purpose of review: Existing research on eating disorders has predominantly centered on affluent, young White cisgender women, limiting providers' understanding of how sociocultural context influences the identification, assessment, and treatment of eating disorders among racial and ethnic minorities. Latino boys and young men remain a particularly understudied group in eating disorder studies, despite growing recognition of the prevalence of eating disorders within Latino populations. This review integrates a synthesis of current literature, epidemiological data, and multidisciplinary perspectives on sex and culture to outline how sociocultural factors, including cultural beliefs such as machismo, acculturation, and family dynamics, impact the development and expression of eating disorders in Latinos.

Recent findings: Findings underscore that Latino boys and young men often present with atypical eating disorder symptoms, such as extreme dietary restrictions and excessive exercise aimed at achieving muscularity. Sociocultural factors (i.e., machismo, acculturative stress, and familial pressures) influence the manifestation and progression of these disorders. These influences are compounded by systemic barriers, such as limited access to culturally responsive care and a lack of awareness among providers regarding diverse eating disorder presentations.

Summary: This review highlights the urgent need for culturally informed diagnostic frameworks and interventions to address the eating disorder experiences of Latino boys and young men.

Purpose of review: Topical corticosteroids (TCS) have long been a mainstay in treating pediatric atopic dermatitis (AD). Topical steroid withdrawal syndrome (TSWS) has garnered increasing public attention, driven largely by social media discourse. This review aims to provide guidance for clinicians to effectively address concerns about pediatric TSWS in order to optimally manage AD in children.

Recent findings: An examination of the literature reveals several misconceptions surrounding TSWS. Research highlights the importance of standardized diagnostic criteria, caution with high- or inappropriate potency TCS, particularly in sensitive areas, and the need for provider-patient communication to improve therapeutic alliance.

Summary: TSWS is gaining recognition, and the lack of consensus on diagnostic standards and similarities with AD flares can result in misdiagnosis. This review highlights practical, evidence-based clinical approaches to discuss TSWS with patients/parents. Strategies to prevent adverse effects from TCS include appropriate potency selection and duration of treatment, utilizing gradual tapering protocols with proactive maintenance therapy, and addition of nonsteroidal anti-inflammatory therapies. Moreover, fostering an open, empathetic doctor-patient relationship can reduce unwarranted phobia around corticosteroids and ensure that TCS continue to be used optimally to treat AD and other inflammatory skin conditions. Thorough clinical guidance is essential to address patient/parent concerns about TSWS while working together toward an effective treatment plan for skin disease.

Purpose of review: The purpose of this review is to provide an update on screening, diagnosis, and treatment of lipid disorders in the pediatric patient.

Recent findings: Apart from the United States Preventive Services Task Force (USPSTF), the majority of medical societies recommend universal screening for lipid disorders in children and adolescents 21 years or younger. Recent population studies confirm lipid abnormalities are prevalent in children, affecting at least one in five children aged 6-19 years. A systematic review and network meta-analysis of lipid-lowering therapies in children and adolescents with familial hypercholesterolemia found that statins reduced LDL-C by 33.61% and adding ezetimibe reduced LDL-C by an additional 15.85%.

Summary: Nearly all major medical societies recommend universal lipid screening in children aged 9-11 and 17-21. Lipid abnormalities are common, and diagnosis is generally made by confirming abnormal lipid results with fasting lipid studies. Lifestyle modifications and statins are the mainstay for treatment of dyslipidemia. However, most research on lipid-lowering therapies is in familial hypercholesterolemia.

Purpose of review: To discuss updated guidelines for the provision of contraception to adolescents, review several contraceptive methods that have entered the market in recent years, and summarize insights from the literature that can assist clinicians in providing accurate, destigmatized contraceptive counseling to patients of all sizes.

Recent findings: The 2024 United States Selected Practice Recommendations (US SPR) and United States Medical Eligibility for Contraceptive Use (US MEC) guidelines include changes to recommendations for contraception use in persons with various health conditions, and new advice for management of implant-associated breakthrough bleeding, pain control for intrauterine device (IUD) insertions, and counseling for patients who take testosterone. Subcutaneous Depo-Provera usage increased during the COVID-19 pandemic, and multiple studies demonstrate favorable patient experiences with it. Annovera, Miudella, Opill, Phexxi, Slynd, and Twirla are newer contraceptives which have distinct features that may make them attractive options for some patients. Contraception-related weight changes continue to be an active area of research. With the Food and Drug Administration (FDA) recommending broader BMI inclusion criteria, providers can expect more information about safety and efficacy of new contraceptives in individuals across the weight spectrum.

Summary: Updated evidence-based guidelines and several new contraceptive options should empower providers to provide patient-centered contraception counseling to patients with a variety of health conditions and contraceptive preferences.