Pediatric Annals最新文献

Adolescence is the phase of life during which most people become sexually active for the first time. It is essential for health care providers to assess the need for pregnancy prevention and provide comprehensive information on contraception, as well as sexually transmitted infection (STI) prevention. All currently available contraceptive methods are safe and effective for most adolescents. Medical, menstrual, and sexual histories should be obtained during the office visit, and all eligible contraceptive methods should be offered. The right method is the one that best fits an adolescent's preferences for efficacy, duration of use, impact on menstrual bleeding, side-effect profile, noncontraceptive benefits, and ease of initiation and discontinuation. All methods can be initiated on the same day if it is reasonably certain that the adolescent is not pregnant. It is also crucial to review that barrier methods are the only contraceptive methods that protect against STI transmission.

Neurodiversity is a term that describes thinking and interacting with the world differently from "typical" thoughts and interactions as held by societal standards. Neurodiversity often highlights diagnoses, like autism spectrum disorder or attention-deficit/hyperactivity disorder, but may include several other developmental disorders. Primary care pediatricians are naturally tied to neurodiversity, as they are often on the forefront of identifying and evaluating for neurodivergent development. There are significant disparities that exist in diagnosing and managing developmental disorders for children from historically marginalized communities. A delay in diagnosis can hinder outcomes, as critical periods of intervention are best early on. When pediatricians use culturally responsive screening and intervention tools, alleviation of these disparities can occur. Combined with tools to improve early identification, as well as connecting health care to educational systems, pediatricians can contribute positively to the development of children with minoritized backgrounds and to the neurodiversity movement.

It is not unusual to detect congenital anomalies in the neonatal period. Fortunately, many of them are benign and inconsequential. These may include branchial cleft cysts, bifid uvula, oral inclusion cysts, and thyroglossal duct cysts. In the newborn period, it is vital for health care providers to be cognizant of the anomalies. The health care provider must differentiate those that are benign and need only reassurance from those that may require additional evaluation and referral. In this article, we discuss the etiologies, clinical presentations, and management of several of these anomalies.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder triggered by food and environmental allergens. Over time, chronic esophageal inflammation can lead to stricturing disease. Current EoE therapies include proton pump inhibitors, swallowed corticosteroids, diet therapy, and biologics. Of these modalities, diet therapy aims to prevent and treat inflammation by removing food triggers from the diet. In this article, the author reviewed both elemental diets and the various types of empiric food elimination diets. Diet therapy may be an option for families seeking alternatives to medication, while offering comparable efficacy depending on the diet. A step-up strategy (ie, starting with 1- or 2-food elimination) is a common first step in diet therapy, helping to minimize dietary restriction and reduce the number of endoscopies required for disease monitoring. Unfortunately, no existing serum or tissue sampling test can accurately identify a food trigger prior to elimination therapy. As such, future advancements in efficacious, noninvasive methods could prove beneficial for individualizing diet therapies, improving adherence, and minimizing treatment risks.

Very early onset inflammatory bowel disease (VEO-IBD), defined by a diagnosis of IBD before age 6 years, poses unique clinical and therapeutic challenges. This review examines differences in clinical manifestations and management for this population, noting important considerations between polygenic and monogenic forms of VEO-IBD. In general, a younger age of onset of IBD is associated with more extensive disease burden and more guarded outcomes compared with adults. For this reason, a comprehensive and multidisciplinary approach involving pediatricians, gastroenterologists, dietitians, and immunologists, among other subspecialties, is vital. Early identification of monogenic disease may allow for targeted therapy selection and improved prognosis, so a high index of suspicion from caretakers is needed. Moving forward, more real-world descriptions, prospective trials, and emerging studies on gene therapy and new mechanisms of action offer promise with a goal for a precision-based approach in this unique population.

Celiac disease is an autoimmune disease caused by a permanent sensitivity to gluten. It manifests as small intestinal enteropathy, which is ongoing intestinal damage, irritation, and swelling. Celiac disease can occur at any age and can present with both gastrointestinal and extraintestinal symptoms, making it challenging to diagnose. Lifelong, strict adherence to a gluten-free diet is currently the only treatment option. After diagnosis, multidisciplinary care, including regular visits with a gastroenterology physician or a dietitian, are useful to help families manage dietary modifications, lifestyle changes, and the psychological burden that adherence to a lifelong treatment regimen can incur. Children often first present with symptoms to their pediatrician, and it is reasonable for pediatricians to initiate celiac serology screening in the appropriate clinical scenario and consider referral to gastroenterology for ongoing care. Knowledge in the primary care setting regarding the presentation of celiac disease, identifying patient populations who are at risk, and ordering the appropriate tests are paramount to prevent diagnostic delay.