Pediatric Annals最新文献

It is not possible for every physician and patient to originate from the exact same circumstances. Because of this impossibility, the dynamics between the patient, caregivers, and physician are extremely important to prevent mistrust, disputes, de-emphasizing the values of others, or miscommunication. Similar to how many diverse groups exist in society so, too, are there numerous factors for influencing how medical care is provided and received. Multiple studies demonstrate the inequalities of access and quality of health care in pediatric primary care as well as increased morbidity and mortality rates. This may be even more prevailing within racial and ethnic communities, which are often underserved populations. This article presents an evaluation of cultural humility and how the awareness of differing viewpoints, values, and norms can assist and improve the medical care of pediatric patients with chronic complex conditions. [Pediatr Ann. 2024;53(3):e88-e92.].

Advances in medical knowledge and treatments have made possible the survival of children with diseases that require lifelong care, and increasing numbers of families with children with medical complexity are presenting for health care. Owing to an increase in home-based care, the responsibility of complicated treatment regimens falls on parents and family caregivers. Based on studies and national survey, parents of children with medical complexity fare worse in mental health and family functioning. This review describes screening tools and research studies for family functioning and psychological health. These data also help in designing a family centered approach to the care of parents and caregivers to create a medical home and community support systems that integrate psychological and emotional interventions. Physician communication can be optimized by educational tools of brief intervention and community connections. [Pediatr Ann. 2024;53(3):e93-e98.].

Heavy menstrual bleeding has a high prevalence and is well documented in adult patients with hypermobile-type Ehlers-Danlos syndrome, but there is limited research surrounding work-up and treatment for the adolescent population. Excessive menstrual blood loss can significantly interfere with emotional and physical quality of life. A provider should acquire a comprehensive medical and menstrual history and focused physical examination, as well as baseline laboratory studies, to determine the presence of anemia or underlying bleeding disorder. Use of a pictorial blood assessment chart may be considered to help quantify the amount of bleeding. Treatment to reduce heavy menstrual flow and referral to specialty care should be initiated swiftly to improve quality of life for this population. [Pediatr Ann. 2024;53(3):e104-e108.].

Children with neurologic impairment are a growing population of pediatric patients who require care from a large team of physicians to maintain their health. These children often have similar clinical patterns and symptoms that occur because of their neurologic impairment. Families often seek care first from their primary care home to identify and guide initial steps in management. Identifying the symptoms outlined in the 4 cases in this article will help alleviate consequences of delayed care for these patients and provide opportunities for shared decision-making with the family's goals of care for their child. [Pediatr Ann. 2024;53(3):e82-e87.].

Sickle cell disease (SCD) is a group of inherited autosomal recessive disorders that affect hemoglobin structure. The presence of this mutated form of hemoglobin, hemoglobin S, results in the abnormally ("sickle") shaped cells. These sickle-shaped red blood cells lead to the disruption of blood flow in small vessels and result in a myriad of complications. Pain, excruciating and unpredictable, is the hallmark of the disease. In addition, many organs are affected, including but not limited to brain, kidneys, bones, and lungs. This leads to varied acute and chronic complications for patients with SCD. Here, we review some of the acute complications of SCD with focus on diagnosis and management. [Pediatr Ann. 2024;53(2):e47-e51.].

Despite advancements in sickle cell disease (SCD) management, individuals with SCD continue to face greater degrees of mortality, disability, and health care barriers compared with their healthy peers. Comprehensive care includes essential elements such as newborn screening, key immunizations, penicillin prophylaxis, and consistent health screening for common complications. Pediatricians should be familiar with treatment options for SCD to offer informed education to both patients and their families. By providing guided and comprehensive care, pediatricians have the potential to enhance both the quantity and quality of life for individuals living with SCD. [Pediatr Ann. 2024;53(2):e43-e46.].

Concussion is a form of traumatic brain injury that occurs commonly in pediatric patients. One group at higher risk for concussion is adolescent and teenage athletes. Athletes may sustain one or more concussions throughout their athletic careers, and these injuries may lead to significant morbidities for children. Although most concussion symptoms will resolve in less than 1 month, there is a subset of patients for whom symptoms may persist. Given the increased interest in preventing long-term sequelae related to concussion, legislation has been passed across the United States that aims to identify concussion promptly and remove participants from play after an injury has occurred. Care and treatment for concussion is evolving, with newer recommendations stating that complete or extreme rest may be unnecessary during the recovery period. Pediatricians and those who interact with young athletes should be aware of the guidelines surrounding return-to-play and return-to-learn in their geographic area of practice. [Pediatr Ann. 2024;53(2):e39-e41.].