Current Problems in Pediatric and Adolescent Health Care最新文献

英文中文

Metabolic and bariatric surgery for adolescents: Progress and persistent challenges 青少年代谢和减肥手术：进展和持续的挑战。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-12-01 DOI: 10.1016/j.cppeds.2025.101890

Zachary Ballinger MD MSCI , Jeremy Aidlen MD

Pediatric obesity, the most common chronic childhood disease in the United States is associated with significant comorbidities that persist into adulthood and increase the risk of early mortality. Metabolic and bariatric surgery (MBS) is the most effective intervention for severe obesity with durable reductions in BMI and obesity-related comorbidities as compared with medical therapy. MBS utilization remains strikingly low. Nearly three million children currently meet eligibility criteria for MBS, yet only about 2500 procedures are performed annually. There are many barriers to accessing MBS, including subspecialty surgeon availability, cost and geographic concentration of multidisciplinary programs, and the substantial burden of perioperative outpatient visits. Primary care physicians remain hesitant to refer adolescents for MBS due to outdated concerns about surgical risks, growth disruption, and adherence to the ineffective strategy of “watchful waiting.” Insurance denials likewise remain a persistent challenge with approval of only 40 % of initial requests for pediatric MBS, leading to delays, program attrition, and widening disparities. These barriers are compounded by persistent socioeconomic and racial inequities. Minority and socioeconomically disadvantaged youth are disproportionately affected by obesity, yet less likely to receive early referral or access to specialized obesity care. At the time of surgery, these patients have higher BMI and more advanced comorbidities, reflecting systemic failures. Despite these challenges, MBS offers transformative, and often lifesaving, benefits. Addressing persistent disparities in access to care by improving physician education, expanding program access and capacity, and reforming insurance policies are essential steps toward equitable access to effective obesity treatment for all children.

儿童肥胖是美国最常见的慢性儿童疾病，与持续到成年的显著合并症相关，并增加早期死亡的风险。与药物治疗相比，代谢和减肥手术（MBS）是治疗严重肥胖最有效的干预措施，可持久降低BMI和肥胖相关合并症。MBS的使用率仍然非常低。目前有近300万儿童符合MBS的资格标准，但每年只有大约2500例手术。获得MBS有许多障碍，包括亚专科外科医生的可用性，多学科项目的成本和地理集中，以及围手术期门诊就诊的大量负担。由于对手术风险、生长中断和坚持无效的“观察等待”策略的过时担忧，初级保健医生仍然对推荐青少年接受MBS犹豫不决。同样，保险拒绝仍然是一个持续的挑战，只有40%的儿科MBS初始申请获得批准，导致延误、项目减员和差距扩大。持续存在的社会经济和种族不平等加剧了这些障碍。少数民族和社会经济上处于不利地位的青年受到肥胖的影响不成比例，但他们接受早期转诊或获得专门的肥胖治疗的可能性较低。在手术时，这些患者有更高的BMI和更晚期的合并症，反映了全身性衰竭。尽管存在这些挑战，但MBS提供了变革性的、往往是挽救生命的好处。通过改善医生教育、扩大项目的可及性和能力以及改革保险政策来解决在获得医疗服务方面持续存在的差距，是实现所有儿童公平获得有效肥胖治疗的关键步骤。

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引用次数: 0

The learning curve of a pediatric bariatric surgery program: Lessons learned from the first 100 patients 儿童减肥手术项目的学习曲线：前100名患者的经验教训。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-12-01 DOI: 10.1016/j.cppeds.2025.101888

Nicolle Burgwardt , Christine Finck , Prabhath Mannam , Darren S. Tishler , Pavlos K. Papasavas , James M. Healy

Introduction

Pediatric obesity continues to be an epidemic and as a result, pediatric surgical programs are developing expertise in bariatric surgery to improve outcomes in these children. This study aims to characterize the pathway from initiation to designation by The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) as a Center of Excellence over the course of our first 100 patients, and examine the implementation and associated learning curve of an institutional pediatric bariatric program at a free-standing children’s hospital.

Methods

Retrospective review of prospectively collected data from the first 100 laparoscopic sleeve gastrectomy patients at a freestanding academic children’s hospital. Patients were separated into quartiles to evaluate outcome measures. Demographics, perioperative and follow-up data were collected to reflect the ASMBS recommended reporting standards.

Results

100 patients were reviewed from 2015–2022. Significant reductions were seen in average operative time (127.6 vs. 65.3 min, p < 0.001), supply cost ($9031.08 vs. $2918.92, p < 0.001), postoperative length of stay (3.2 vs. 2.0 days, p < 0.001), and postoperative narcotic usage (8.4 vs. 1.8 doses, p < 0.001), between the first and fourth quartiles. Beginning in 2019, quality improvement initiatives were developed annually.

Conclusion

Partnership with an established high-volume bariatric center and accumulation of experience, followed by systematic implementation of quality and safety measures through MBSAQIP, can substantially improve the care provided to adolescent patients during the building of a pediatric bariatric program.

儿童肥胖仍然是一种流行病，因此，儿科外科项目正在发展减肥手术的专业知识，以改善这些儿童的预后。本研究旨在描述前100名患者从启动到被代谢和减肥手术认证和质量改进计划（MBSAQIP）指定为卓越中心的过程，并检查独立儿童医院机构儿科减肥计划的实施和相关学习曲线。方法：回顾性分析某独立学院型儿童医院前100例腹腔镜袖胃切除术患者的前瞻性资料。将患者分成四分位数来评估结果。收集人口统计学、围手术期和随访数据，以反映ASMBS推荐的报告标准。结果：2015-2022年共纳入100例患者。平均手术时间（127.6 vs. 65.3 min, p < 0.001）、供应成本（9031.08 vs. 2918.92美元，p < 0.001）、术后住院时间（3.2 vs. 2.0天，p < 0.001）和术后麻醉使用（8.4 vs. 1.8剂量，p < 0.001）在第一和第四四分位数之间显著降低。从2019年开始，每年制定质量改进计划。结论：与已建立的大型减肥中心合作，积累经验，然后通过MBSAQIP系统地实施质量和安全措施，可以在建立儿科减肥项目期间大大改善对青少年患者的护理。

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Editorial Board Page 编委会页面

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/S1538-5442(25)00176-2

引用次数: 0

Keeping patients moving: Understanding appropriate adaptive devices for positioning and mobility 保持患者活动：了解适当的定位和活动的适应性装置。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101879

Julie Will , Mi Ran Shin , Brooke Jerome , Karla Feitl , Amanda Hall , Olga Morozova

Children and youth with special healthcare needs (CYSHCN) face numerous challenges throughout their lives. Various assistive and adaptive devices can substantially enhance the function, accessibility, and overall quality of life for these patients. However, the process of selecting and ordering durable medical equipment (DME) differs significantly from the routine treatment plans, potentially becoming overwhelming. It is crucial that pediatricians and primary care providers recognize the necessity of assistive and adaptive devices. This paper explores the domain of adaptive devices for positioning and mobility, providing overview of commonly used DME, explaining their indications, distinguishing the advantages and disadvantages of various devices, and detailing the process of ordering DME.

有特殊保健需要的儿童和青少年在其一生中面临着许多挑战。各种辅助和自适应设备可以大大提高这些患者的功能，可及性和整体生活质量。然而，选择和订购耐用医疗设备（DME）的过程与常规治疗计划有很大不同，可能会变得势不可挡。至关重要的是，儿科医生和初级保健提供者认识到辅助和适应性装置的必要性。本文探讨了用于定位和移动的自适应装置领域，概述了常用的DME，解释了它们的适应症，区分了各种装置的优缺点，并详细介绍了订购DME的过程。

引用次数: 0

Pediatric stroke: From emergent evaluation to rehabilitation 小儿中风：从紧急评估到康复。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101878

Mejdi Najjar, Melissa Fleming

Pediatric stroke, though less common than adult stroke, is a significant cause of morbidity and mortality in children, affecting neonates, infants, and adolescents. Strokes in children could be due to ischemic, hemorrhagic, or venous-thrombotic events. Timely recognition and intervention to optimize neurologic outcomes and minimize long-term disability is most critical. Clinical symptoms are dependent on location of the stroke, but pediatric-specific challenges include higher prevalence of stroke mimics and more frequent seizures. Rapid diagnosis hinges on detailed history, neurologic examination, and emergent imaging, with MRI and angiography preferred for evaluating ischemia and vascular anomalies.

Hyperacute treatments include intravenous thrombolysis and mechanical thrombectomy. Risk factors are often multifactorial, including congenital heart disease, sickle cell disease, and thrombophilia. Acute complications may involve cerebral edema, hemorrhagic conversion, and post-stroke epilepsy.

Rehabilitation is essential and begins early in the intensive care unit. A multidisciplinary team—including physical, occupational, and speech therapists alongside physiatrists—supports recovery. Rehabilitation intervention includes uses of orthoses to improve function, prevent complications, impairment specific treatment including constraint-induced movement therapy (CIMT) and goal-oriented hypertonia management. Cognitive and communication impairments also require tailored therapies and school reintegration planning.

Although neural plasticity offers potential for recovery, many children experience persistent motor, cognitive, and psychosocial deficits. Early, aggressive rehabilitation and coordinated outpatient care are key to maximizing functional outcomes and improving long-term quality of life.

小儿中风虽然不如成人中风常见，但却是儿童发病和死亡的重要原因，影响新生儿、婴儿和青少年。儿童中风可由缺血性、出血性或静脉血栓事件引起。及时识别和干预以优化神经预后和减少长期残疾是最关键的。临床症状取决于中风的位置，但儿科特有的挑战包括更高的中风模拟患病率和更频繁的癫痫发作。快速诊断依赖于详细的病史、神经系统检查和紧急成像，首选MRI和血管造影来评估缺血和血管异常。超急性期治疗包括静脉溶栓和机械取栓。危险因素通常是多因素的，包括先天性心脏病、镰状细胞病和血栓病。急性并发症可能包括脑水肿、出血性转化和卒中后癫痫。康复是必不可少的，并在重症监护病房的早期开始。一个多学科的团队，包括物理，职业，语言治疗师和理疗师，支持康复。康复干预包括使用矫形器来改善功能，预防并发症，损伤特异性治疗，包括约束诱导运动疗法（CIMT）和目标导向的高张力管理。认知和沟通障碍也需要有针对性的治疗和重新融入学校的规划。尽管神经可塑性提供了恢复的潜力，但许多儿童经历了持续的运动、认知和社会心理缺陷。早期，积极的康复和协调的门诊护理是最大限度地提高功能结果和改善长期生活质量的关键。

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引用次数: 0

Neurofibromatosis review with focus on rehabilitation intervention 神经纤维瘤病综述，重点是康复干预。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101886

Mi Ran Shin MD, MPH , Mackenzie Brown MD , Benjamin Siegel MD , Sinan Turnacioglu MD

Neurofibromatosis Type 1 (NF1) is a complex, multisystem genetic disorder characterized by cutaneous, neurologic, orthopedic, and cognitive manifestations. Affecting approximately 1 in 3000 individuals worldwide, NF1 has a variable phenotype, but children commonly present with a combination of cognitive impairment, learning disabilities, attention-deficit/hyperactivity disorder (ADHD), motor coordination deficits, behavioral challenges, chronic pain, and orthopedic complications. Functional impairments often manifest in both gross and fine motor domains, with gait abnormalities, hypotonia, and reduced endurance. Chronic pain, especially related to plexiform neurofibromas, further impacts quality of life and is associated with neuronal hyperexcitability in the context of neurofibromin deficiency. Rehabilitation plays a critical role in improving function and quality of life by integrating interdisciplinary therapies, educational support, family education, and individualized goal-setting. A comprehensive approach is essential for identifying and managing the diverse impairments associated with NF1 across developmental stages.

1型神经纤维瘤病（NF1）是一种复杂的多系统遗传性疾病，以皮肤、神经、骨科和认知表现为特征。在全球范围内，每3000人中就有1人感染NF1， NF1具有可变的表型，但儿童通常表现为认知障碍、学习障碍、注意力缺陷/多动障碍（ADHD）、运动协调缺陷、行为挑战、慢性疼痛和骨科并发症。功能损伤通常表现在粗大和精细运动领域，步态异常，张力低下和耐力降低。慢性疼痛，特别是与丛状神经纤维瘤有关的慢性疼痛，进一步影响生活质量，并与神经纤维蛋白缺乏的情况下神经元的高兴奋性有关。通过跨学科治疗、教育支持、家庭教育和个性化目标设定，康复在改善功能和生活质量方面发挥着关键作用。一个综合的方法对于识别和管理不同发育阶段与NF1相关的各种损伤是必不可少的。

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引用次数: 0

Congenital muscular torticollis: Diagnosis, management, and prognosis in the pediatric population 先天性肌性斜颈：儿科人群的诊断、管理和预后。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101877

Leslie Phillips DNP, Kelly Walsh PT, Justin Burton MD

Congenital muscular torticollis (CMT) typically is due to unilateral shortening of fibrosis of sternocleidomastoid muscle. Timely diagnosis and management are essential for improving outcomes in children. Within CMT, there are several classifications with variable prognosis: postural, muscular, and sternomastoid tumor group. The diagnosis of CMT involves comprehensive physical assessment. Treatment of CMT typically involves conservative treatment that includes physical therapy, but can involve pharmacologic treatment with botulinum toxin injections, and at worst case, surgical treatment. Caregiver education is the key to successful treatment.

先天性肌性斜颈（CMT）通常是由于单侧胸锁乳突肌纤维化缩短。及时诊断和管理对于改善儿童预后至关重要。在CMT中，有几种预后不同的分类：体位、肌肉和胸锁乳突瘤组。CMT的诊断包括全面的体格评估。CMT的治疗通常包括保守治疗，包括物理治疗，但也可以包括注射肉毒杆菌毒素的药物治疗，在最坏的情况下，手术治疗。护理人员教育是治疗成功的关键。

引用次数: 0

FOREWORD: Rehabilitation Approaches in Complex Pediatric Diagnosis 前言：复杂儿科诊断中的康复方法。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101876

Louis M. Bell MD

引用次数: 0

Paroxysmal sympathetic hyperactivity in children: An updated narrative review 儿童阵发性交感神经过动症：最新的叙述回顾。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101887

Justin Burton , Mi Ran Shin , Annie Abraham , Olga Morozova

Paroxysmal sympathetic hyperactivity is a clinical syndrome seen in many different types of brain injuries with potentially life-threatening consequences. It typically includes a constellation of symptoms: tachycardia, tachypnea, hyperthermia, hypertension, diaphoresis, hypertonia, and/or decerebrate or decorticate posturing. It is a clinical diagnosis of exclusion. A multimodal treatment approach is necessary including environmental modifications along with pharmacotherapy. Early management can help prevent comorbidities and improve patient outcomes.

阵发性交感神经过度活跃是一种临床综合征，可在许多不同类型的脑损伤中看到，具有潜在的危及生命的后果。它通常包括一系列症状：心动过速、呼吸急促、高热、高血压、出汗、高渗和/或痴呆或脱皮姿势。这是一种排除性的临床诊断。多模式治疗方法是必要的，包括环境改变和药物治疗。早期治疗有助于预防合并症并改善患者预后。

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A practical guide to strength/resistance training in pediatrics ages 7 through 18 years old 7至18岁儿科力量/阻力训练的实用指南

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-11-01 DOI: 10.1016/j.cppeds.2025.101885

Jeff Rabin , Shannon Bowles , Mi Ran Shin

Resistance training in the pediatric population is often surrounded by myths and misconceptions, making it challenging to provide clear recommendations. However, evidence supports that resistance training, when appropriately designed and supervised, is both safe and effective for children and adolescents aged 7 to 18 years. Programs may incorporate bodyweight exercises, free weights, resistance bands, machines, and suspension systems such as TRX. When developmentally appropriate, resistance training not only promotes muscular strength and endurance but also supports healthy growth, motor coordination, bone health, and overall physical development.

儿科人群的阻力训练经常被神话和误解所包围，这使得提供明确的建议具有挑战性。然而，有证据表明，在适当的设计和监督下，阻力训练对7至18岁的儿童和青少年既安全又有效。项目可以包括体重练习，自由重量，阻力带，机器和悬挂系统，如TRX。当发育合适时，抗阻训练不仅能增强肌肉力量和耐力，还能促进健康生长、运动协调、骨骼健康和整体身体发育。

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