Pediatric Annals最新文献

Autonomic dysfunction, particularly postural orthostatic tachycardia syndrome (POTS), is increasingly recognized in adolescents and young adults. Early recognition in primary care is critical, as these conditions can substantially affect functioning, school participation, quality of life, and health care utilization. This review provides practical, clinically relevant guidance for pediatric and family medicine clinicians, and emphasizes recognition, office-based assessment, initial management, and referral strategies. Key considerations include differentiating POTS from mimicking conditions, evaluating functional impact, and implementing structured lifestyle interventions. Medications are reserved for patients with significant functional impairment despite conservative management, with a focus on setting realistic expectations. Case vignettes illustrate common phenotypes and highlight practical approaches to individualized care. By providing clear frameworks for evaluation and management, primary care clinicians can reduce unnecessary specialty visits, improve patient outcomes, and facilitate coordinated care across multidisciplinary teams.

Chronic orthostatic intolerance (COI), a common symptom of autonomic dysfunction (AD), in adolescents is a heterogeneous condition characterized by symptoms that worsen upon standing and improve with recumbency. Nonpharmacologic management is the foundation of treatment and focuses on restoring autonomic balance, improving conditioning, and supporting functional recovery. This review summarizes current evidence-based strategies, including volume expansion through increased fluid and salt intake, use of compression garments, and gradual reconditioning exercises. Additional approaches, such as optimizing sleep, nutrition, and psychological well-being, address the multifactorial contributors to COI/AD. Education and reassurance play key roles in reducing symptom-related anxiety and promoting adherence. A multidisciplinary approach involving clinicians, families, and schools can enhance long-term outcomes. Emphasizing functional improvement fosters resilience and recovery, aligning treatment goals with adolescent development and quality of life. Clinicians should prioritize early education and behavioral interventions to promote sustainable recovery without reliance on medication.

Pediatric asthma is a prevalent chronic respiratory condition requiring effective management strategies to prevent exacerbations and improve long-term outcomes. Inhaled corticosteroids (ICS) remain the foundation of asthma control, often combined with long-acting beta-2 agonists (LABAs) to enhance symptom relief. However, adherence challenges with separate maintenance and reliever inhalers have led to the emergence of maintenance and reliever therapy (MART) as an alternative approach. MART combines ICS and formoterol into a single inhaler for both maintenance and symptom relief, simplifying treatment regimens and ensuring consistent anti-inflammatory therapy. Recent studies demonstrate that MART reduces exacerbations, improves asthma control, and enhances adherence, compared with traditional ICS-LABA therapy. However, concerns remain regarding its long-term safety, potential overuse, and effects on growth and development. This review explores the rationale, clinical efficacy, and special considerations for MART in pediatric asthma, emphasizing the need for further research to refine its role in individualized treatment strategies.

How is postural orthostatic tachycardia syndrome (POTS) diagnosed? What about adolescents who seem to have POTS but do not meet the diagnostic criteria? How can we treat POTS and related conditions? How can we best respond to common questions of frustrated patients and parents and guardians? This article provides evidence- and expert-based answers to questions that frequently arise when caring for patients with POTS and related conditions.

Disorders of the autonomic nervous system commonly present with symptoms of orthostatic intolerance in children and adolescents. These conditions frequently manifest with a combination of orthostatic dizziness and gastrointestinal (GI) symptoms, including pain, nausea, vomiting or regurgitation, changes in bowel habits, or altered nutritional intake, in addition to extraintestinal symptoms (eg, fatigue, joint pains, sleep disturbance) leading to functional impairment. It is necessary for frontline medical professionals to understand the interplay among symptoms within these disorders to more accurately characterize an individual patient's disorder toward appropriate testing and management. Treatment for orthostatic and GI disorders should emphasize a holistic biopsychosocial model of care aimed at addressing patient symptoms, identifying and managing concurrent conditions, supporting nutritional needs along with normal pediatric growth and development, and supporting return to normal physical, mental, and social functioning.

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.