Pediatric Annals最新文献

Vaccine hesitancy has increased in recent years, driven by misinformation, shifting public discourse, and declining trust in traditional medical guidance. Pediatric clinicians are increasingly tasked with addressing parental concerns related to vaccine safety, ingredients, adverse effects, and perceived necessity. Common contributors to hesitancy include persistent myths linking vaccines to autism, misunderstandings about vaccine ingredients, policy-related confusion, and religious or personal beliefs. Media and social platforms play a significant role in amplifying misinformation, creating challenges for clinical practice. Addressing vaccine hesitancy requires empathetic, evidence-based communication, proactive educational strategies within pediatric clinical settings, and thoughtful engagement with families who are vaccine hesitant. The growing emotional and time burden associated with these discussions underscores the need for institutional support to sustain the pediatric workforce while ensuring protection of child and community health.

The number of sedation programs that offer pediatric procedural sedation outside of the operating room has grown over the past decade. With this growth, sedation programs are continuously improving the safety and quality for patients undergoing natural airway sedation. The first and most important step to ensuring safe and successful sedation is identifying the right candidates. Patient selection is systematic, with a prescreening process that includes a review of medical history and mandates a focused physical examination to identify risks that would disqualify the patient from a sedated procedure by a non-anesthesia-trained practitioner. The main goal of prescreening is to identify any airway, respiratory, cardiovascular, or neurologic features that may create an unreasonable risk for the intended procedure. This article will cover key aspects of the screening process that helps determine candidacy for pediatric procedural sedation by non-anesthesia-trained practitioners and includes a discussion on special patient populations and high-risk medical conditions.

The current demand for pediatric procedural sedation outside the operating room often exceeds the capacity of pediatric anesthesiologists and can safely be offered by well-trained pediatric practitioners within a structured sedation program. High-fidelity simulation curricula and competency-based assessments offer a skills-based pathway to credentialing. Published safety and quality data support endeavors that expand pediatric procedural sedation programs staffed by trained nonanesthesiologist practitioners, including pediatric hospitalists. This article reviews recommended core competencies required for pediatric procedural sedation and provides pathways to achieving and maintaining pediatric sedation credentials and hospital privileges.

Children who are neurodivergent have higher rates of injury, number of health care visits, and perceived need for sedation compared with their peers who are not neurodivergent, resulting in unique medical care challenges for this patient population. Sedation of children who are neurodivergent is challenging due to increased risk of adverse events, medication interactions, and behavioral complexities. Safe and effective sedation requires individualized planning, careful agent selection, and incorporation of nonpharmacologic strategies. Significant variability exists in sedation practices for children who are neurodivergent, highlighting the need for greater education and clinical guidelines. Sedation clinicians should consider the potential sensory sensitivity and communication limitations of a child who is neurodivergent. Environmental modifications, tailored communication strategies, sensory tools, caregiver involvement, and individualized coping plans may be beneficial. Future research should prioritize patient- and family-centered care goals, evidence-based design of neurodivergent-friendly settings, standardized sedation protocols, customized sedative dosing for the neurodiverse population, and expansion of home desensitization programs to improve safety, comfort, and equity in care for patients who are neurodivergent.

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. This review, the first installment of a two-part series, provides practical guidance for primary care pediatricians on five commonly encountered dermatologic conditions: cutaneous mastocytosis, granuloma annulare, contact dermatitis and id reactions, bullous impetigo, and periorificial dermatitis. 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 pediatricians with essential tools for addressing dermatologic conditions in children.

There is growing concern regarding potential neurotoxicity and long-term neuro-cognitive outcomes in young children receiving general anesthetics (GAs) and sedatives. Most currently used anesthetics and sedatives have shown to be potentially neurotoxic in animal studies. However, three landmark human studies have provided compelling evidence that a single brief exposure to GAs at an early age does not affect neurocognitive or behavioral outcomes. It is unclear if multiple exposures to GAs and sedatives in early childhood lead to worse neurocognitive or behavioral outcomes. This review article will summarize the evidence in both animal and human studies and discuss the limitations in both. Furthermore, we will suggest strategies to limit GA and sedative exposure in young children, as well as propose future directions of study.

The practice of safe and effective procedural sedation in children requires a comprehensive sedation plan that accounts for procedural requirements, as well as patient-specific needs. When tailoring a sedation plan, a combination of nonpharmacologic and pharmacologic tools is often required, and within each group, many different options exist. This article presents a high-level overview of the most commonly employed tools, such as preparatory techniques, distraction modalities, nonpharmacologic analgesia, and comfort positions, as well as common sedatives, adjuncts, and combinations. With a focus on practical application and tool-specific nuances, this article serves as a valuable resource for practitioners aiming to develop or expand their procedural sedation skillset, as well as those who do not currently practice procedural sedation but want to gain a better understanding of this evolving field.

Eczema coxsackium, a more severe manifestation of hand, foot, and mouth disease, is primarily caused by coxsackievirus A6 and A16. It predominantly affects children with atopic dermatitis and is characterized by vesicular, bullous, and erosive eruptions on both active and inactive eczematous skin, including involvement of the oral mucosa, typically following a brief febrile prodrome. We report an atypical case of eczema coxsackium in an 8-month-old with a history of atopic dermatitis who presented with a widespread rash and prolonged fevers without typical oral lesions. The diagnosis of eczema coxsackium was made based on clinical findings and history. This illustrative case underscores the importance of considering eczema coxsackium in the differential diagnosis of viral exanthems, particularly in children with atopic dermatitis.