Pediatric Annals最新文献

Pediatric bipolar disorder (PBD) is a severe and often debilitating psychiatric condition that most often is diagnosed during later adolescence; though, rarely, it can occur in younger children. While it is strongly recommended that youth who present with concerns for PBD be referred to a specialist (eg, child and adolescent psychiatrist), pediatric primary care clinicians (PCCs) play an important role in the assessment of PBD, as delays in recognition of the disorder are associated with a more severe clinical course and poorer functional outcomes. Properly diagnosing PBD is made more difficult due to previous and ongoing disagreements in the PBD field regarding how the disorder presents in youth, especially prior to puberty. This article will address this controversy; review diagnostic criteria, epidemiology, and typical clinical course; and provide critical information that pediatric PCCs can incorporate into their assessment approach to improve their confidence and skills in diagnosing PBD.

Dermatologic complaints are commonly encountered in pediatric primary care, accounting for up to 30% of visits; yet, diagnostic error rates remain high due to limited dermatologic training during pediatric residency training. This article, the second installment of a two-part series, provides practical guidance for primary care pediatricians on five commonly encountered dermatologic conditions: keratosis pilaris and variants, pity-riasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica, neonatal vs infantile acne, Gianotti-Crosti syndrome, and urticarial eruptions. For each condition, key clinical features, diagnostic challenges, and evidence-based management strategies are discussed, with a focus on empowering pediatricians to make timely and accurate diagnoses and improve patient outcomes. Emphasis is placed on the importance of patient and family education, recognition of clinical signs, and management approaches. This series aims to bridge existing knowledge gaps and provide pediatric clinicians with essential tools for addressing dermatologic conditions in children.

Obsessive-compulsive disorder (OCD) affects an estimated 1% to 3% of children and adolescents, and frequently results in significant academic, social, and family impairment. Early onset is associated with increased severity, chronicity, and psychiatric comorbidity, yet delays in recognition remain common. Pediatricians are often the first clinicians to encounter affected youth and are therefore essential in early identification and referral. Diagnosis is clinical, supported by validated screening instruments, such as the Children's Yale-Brown Obsessive-Compulsive Scale. Cognitive-behavioral therapy with exposure and response prevention is the first-line treatment, with selective serotonin reuptake inhibitors serving as evidence-based adjuncts for moderate to severe cases. Family-based interventions and psychoeducation further enhance outcomes. For treatment-resistant cases, augmentation with clomipramine or low-dose antipsychotics may be considered under specialist guidance. Sustained therapy and relapse prevention strategies are critical to maintaining remission. Early recognition and coordinated care can substantially improve prognosis for youth with OCD.

Aggression and self-injury are common challenges for youth with autism spectrum disorder (ASD), often impacting safety, ability to access services and community resources, and quality of life for children, adolescents, and their families. As pediatricians and other pediatric primary care physicians are often tasked with managing these problems, this review outlines the evidence and potential strategies in both the assessment and management of aggression and self-injury for youth with ASD. Assessment begins with evaluating safety risks and identifying contributing factors, such as medical conditions, communication difficulties, environmental stressors, reinforcement patterns, and psychiatric comorbidities. Evidence-based behavioral interventions, including applied behavior analysis, functional behavioral analysis, functional communication training, and parent training programs, form the foundation of treatment, supplemented by school-based and protective equipment interventions where appropriate. Pharmacologic interventions may be considered when behavioral approaches are insufficient, but they show variable efficacy in managing aggression or self-injury.

Pediatricians and all other pediatric primary care clinicians are likely to encounter youth who report symptom concerns of psychosis, such as auditory or visual hallucinations. It is essential for clinicians to be comfortable evaluating and triaging these symptoms, including assessment of co-occurring safety concerns, to ensure access to appropriate treatment. Due to limited specialty mental health resources nationwide, pediatricians may also be tasked with initiating medications or referring directly to evidence-based psychosocial interventions in the community. This article reviews different types of psychotic symptoms seen in youth and suggested next steps one may take in assessment, management, and referrals.