Pediatric Annals最新文献

Advances in cancer treatment and supportive care have resulted in more than 80% of pediatric cancer patients surviving into adulthood. This progress has prompted consideration of factors influencing long-term quality of life for patients, including fertility. The ability to have biological children is important to many survivors. Yet, gonadotoxic therapies, such as alkylating agents and radiation, can damage gonadal tissues and cause infertility. Since these treatments remain essential for cure, efforts have expanded to better understand fertility risks and preservation strategies. Prominent organizations, including the American Society for Reproductive Medicine, American Society of Clinical Oncology, American Academy of Pediatrics, Association of Pediatric Hematology/Oncology Nurses, and Children's Oncology Group, recommend all cancer patients receive comprehensive counseling on fertility risks and options. This review outlines current knowledge on fertility risk, preservation strategies, care barriers, and future directions to improve fertility preservation access and outcomes for pediatric cancer patients and survivors.

Following cancer treatment, childhood cancer survivors (CCS) are at risk for adverse physical, psychosocial, functional, and behavioral long-term health outcomes, known as "late effects." Risk for late effects is individualized based on the survivor's treatment exposures and can occur years or decades after treatment. Lifelong survivorship care is needed for screening, prevention, and treatment of late effects. Studies have shown that survivor-focused care declines over time; however, survivors remain engaged with regular medical care. It is important for primary care health care professionals to be aware of resources when caring for this unique population. Multiple domestic and international guidelines are available to provide recommended evaluations for cancer survivors based on their treatment exposures. This review highlights important topics relevant for health care professionals caring for CCS, including organ system-specific late effects, psychosocial care, subsequent neoplasms, immunizations, and transition of medical care.

Informed consent is a guiding principle underpinning medical care. In pediatrics, most patients are unable to provide consent by nature of their age and maturity, and the responsibility for providing informed permission falls to the child's parent or guardian. However, in most circumstances, the child should be involved in discussions about their medical care and sometimes can give assent to their care. In pediatric oncology, where clinical research is often enmeshed in clinical care, the processes of informed consent and assent may be even more complex. Pediatric oncology clinicians must be able to communicate the goals, potential benefits and risks, and anticipated side effects (of both routine care and involvement in research studies), while being attuned to the parents' or guardians' emotional state and understanding. While obtaining consent and assent can be complex and even challenging, familiarity with their ethical rationale is essential for pediatric clinicians.

Although survival rates for pediatric cancer diagnoses have improved significantly, persistent health disparities prevent many children and adolescents in the United States from reaping equitable benefit from this progress. This review examines inequities related to race and ethnicity, language preference, socioeconomic status, and geographic location. A literature search identified 33 articles highlighting how these factors intersect to affect diagnosis, treatment access, clinical trial participation, and outcomes. Black patients and Hispanic patients face consistently poorer survival, while language barriers are linked to delayed care and increased mortality. Low socioeconomic status and lack of insurance contribute to late-stage diagnoses and treatment nonadherence. Residence in rural areas or historically marginalized urban neighborhoods are associated with increased mortality. Disparities in clinical trial enrollment further limit access to cutting-edge therapies and weaken the generalizability of research. Addressing these disparities requires systemic reform, culturally informed care, and inclusive research practices to ensure equitable outcomes.

International travel can be exciting but carries specific health risks if not appropriately planned. Primary care pediatricians should be prepared to provide timely, tailored pre-travel health counseling for families to ensure adequate time for necessary immunizations and prophylactic medications, in addition to ensuring routine vaccinations are up to date. Further counseling on risk-reducing behaviors and strategies to manage common travel-related health issues should also be provided. For patients who have medical conditions that may lead to an immunocompromised status, which may require specialized guidance or vaccines not routinely available in primary care, referral to a travel medicine clinician is indicated to optimize the patient's health and safety. Pre-travel counseling should also include guidance on recognizing and seeking care for acute illness after returning from travel to prevent serious morbidity and the spread of highly contagious infections.

Deleterious changes in cancer predisposition genes can increase the risk for malignancy in children starting as early as birth. Pending the potential introduction of universal screening programs, in which all newborns may be tested for pathogenic/likely pathogenic variants in established susceptibility genes, coordination amongst health care professionals (including the pediatrician) is necessary to identify children with hereditary syndromes at a young age and to initiate surveillance. This review provides a high-level overview of cancers that are observed in the first year of life, genes known to confer germline predisposition, methods for cancer detection beyond the well-child examination, and areas of current research.

Dietary fibers are carbohydrates that are neither digested nor absorbed in the intestine. From regulation of blood glucose and cholesterol to treatment of constipation, irritable bowel syndrome, and inflammatory bowel disease, fiber has an important role in both disease prevention and treatment within the gastrointestinal system and beyond. The US Department of Agriculture's 2020-2025 Dietary Guidelines for Americans identify fiber as underconsumed across age groups, with many studies showing that dietary fiber intake is low in most children consuming a Western diet. Understanding which foods are rich in fiber is key to increasing intake; however, lack of variety in a child's diet can make it difficult to meet the daily recommended intake for dietary fiber. The purpose of this article is to review the importance of fiber in a child's diet, including disease treatment and prevention, and provide practical advice for clinicians and families about fiber intake for children.

Pediatric primary care clinicians are instrumental in addressing picky eating. While a normal part of human development, picky eating can lead to nutritional deficiencies and unnecessary stress if not managed properly. Picky eating occurs on a spectrum, from benign and age-appropriate issues (eg, neophobia) to pathologic feeding disorders (eg, avoidant/restrictive food intake disorder, pediatric feeding disorder). This article serves as a call to action for pediatric care teams to understand the nuances of picky eating and advocate for families struggling to feed their children. An action plan is proposed to determine picky eating severity that recommends baseline nutrition strategies with consideration to a child's accepted foods while conveying the need for specialist referral if there is no improvement. Pediatric care teams must utilize a compassionate and informed approach to support families navigating the stress of picky eating with a goal of positive mealtime experiences and optimized nutrition.