Recent advances in addressing vaccine hesitancy
Purpose of review
To offer healthcare providers current, evidence-based approaches for addressing vaccine hesitancy to increase vaccine coverage and reduce the frequency of vaccine-preventable disease outbreaks.
Recent findings
Vaccine hesitancy is a growing problem with profound societal, economic, and medical consequences. Understanding the complexity of vaccine hesitancy can inform approaches to increasing vaccine uptake on both the individual and population levels. Notably, pediatricians play a critical role in increasing vaccine uptake due to their relationships with families. This doctor–patient relationship e...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research
Adolescent suicide: what can pediatricians do?
This article will review the changing rates of suicide, discuss recent literature on risk factors, identify methods to screen for suicidal thoughts and suggest an approach to counseling a suicidal patient. Finally, there will be a brief discussion on safety planning and public health measures to help reduce suicide rates.
Recent findings
Rates of attempted suicide and death by suicide have been increasing for more than a decade. Risk assessment of potential suicidality remains very challenging, as the risk factors are multifactorial. However, some common risk factors persist including sexual minority identification and ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: OFFICE PEDIATRICS: Edited by Henry H. Bernstein Source Type: research
Treatment of cardiometabolic risk factors in patients with type 1 diabetes
This article reviews recent evidence on cardiometabolic risk factors and their management in youth with T1D.
Recent findings
Adolescents with T1D show early signs of vascular complications, as a result of several cardiometabolic risk factors. Poor glycemic control is one of the main risk factors and the main target of treatment. However, only a minority of adolescents with T1D reaches recommended targets for glycemic control. Hypertension, dyslipidemia, smoking, alcohol use, obesity and insulin resistance are other common cardiometabolic risk factors in this age group. Recent data confirm that screening for these risk f...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
Obesity and insulin resistance in children
Purpose of review
It is well known that obesity represents the main modifiable risk factor for insulin resistance in children and adolescents; obesity-induced insulin resistance in children is the most important risk factor for developing cardiovascular diseases and type 2 diabetes in adulthood. The mechanisms through which obesity causes insulin resistance are complex and not completely known to date.
Recent findings
In children, global adiposity is the main factor determining insulin resistance. Excessive fatty acids play a determinant role in the pathogenesis of insulin resistance in obese children, inducing an inc...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
Update on adrenarche
Purpose of review
Adrenarche is the pubertal maturation of the innermost zone of the adrenal cortex, the zona reticularis. The onset of adrenarche occurs between 6 and 8 years of age when dehydroepiandrosterone sulfate (DHEAS) concentrations increase. This review provides an update on adrenal steroidogenesis and the differential diagnosis of premature development of pubic hair.
Recent findings
The complexity of adrenal steroidogenesis has increased with recognition of the alternative ‘backdoor pathway’ and the 11-oxo-androgens pathways. Traditionally, sulfated steroids such as DHEAS have been considered to be inac...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
Diagnosis and management of pediatric metabolic bone diseases associated with skeletal fragility
Purpose of review
The goal of this review is to give an overview of diagnosis and up-to-date management of major pediatric metabolic bone diseases that are associated with bone fragility, including nutritional rickets, hypophosphatemic rickets, osteogenesis imperfecta, Ehlers--Danlos syndrome, Marfan's syndrome, hypophosphatasia, osteopetrosis and skeletal fluorosis.
Recent findings
During the past decade, a number of advanced treatment options have been introduced and shown to be an effective treatment in many metabolic bone disorders, such as burosumab for hypophosphatemic rickets and asfotase alfa for hypophosphata...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
Clinical expression of endocrine disruptors in children
Purpose of review
Health status is the result of complex interaction between individual factors, general environmental factors and specific factors as nutrition or the presence of chemicals. Aim of this review is to point out the more recent knowledge covering the role of the endocrine disrupting chemical (EDC) on pediatric population wellbeing.
Recent findings
Prenatal, postnatal life and puberty are the three main temporal windows of susceptibility when EDCs may act. The mechanism is independent from dose or duration of exposition, sex, age or combination of chemicals and may also be transgenerational, affecting bot...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
Use of sleeve gastrectomy in adolescents and young adults with severe obesity
Purpose of review
The prevalence of pediatric obesity and its associated complications is increasing around the world. Treatment of obesity is challenging and metabolic and bariatric surgery (MBS) is currently the most effective treatment for this condition. At this time, vertical sleeve gastrectomy (VSG) is the most commonly performed bariatric procedure in adolescents. However, knowledge regarding the efficacy, safety, and durability of VSG in adolescents is still evolving. This review summarizes the most recent updates in the field of MBS particularly VSG in adolescents.
Recent findings
MBS is recommended to treat ...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: ENDOCRINOLOGY AND METABOLISM: Edited by Sally Radovick Source Type: research
PIK3CA vascular overgrowth syndromes: an update
Purpose of review
Over the past decade many previously poorly understood vascular malformation disorders have been linked to somatic activating mutations in PIK3CA, which regulates cell survival and growth via activation of the mTOR1-AKT pathway. The goal of this article is to describe and provide an update on the clinical features, complications, and management strategies for the PIK3CA-related overgrowth spectrum (PROS).
Recent findings
PROS encompasses a heterogenous group of disorders with complications related to the tissues harboring the mutation. Vascular malformation syndromes, such as Klippel–Trenaunay synd...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Pediatric mastocytosis
Purpose of review
The current article highlights recent developments in the field of pediatric cutaneous mastocytosis. Mastocytosis is a spectrum of conditions that range from fleetingly benign to aggressively malignant. Through recognizing the natural progression of disease, the role of biomarkers and mutational analysis, treatment and risk of triggers, physicians can confidently stage, counsel and manage patients with pediatric cutaneous mastocytosis.
Recent findings
Many lesions of cutaneous mastocytosis are chronic with some resolving around the mid-teenage years. KIT mutations are found in the majority of pediatr...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Pediatric contact dermatitis: what's new
Purpose of review
Allergic contact dermatitis (ACD) was once thought to be rare in children but recent studies have demonstrated that the prevalence of ACD is common and appears to be increasing in children. Current trends including toys, hobbies, and personal care products may play a role in potentially new allergen exposure or resurgence of certain allergens, making ACD a moving target in children.
Recent findings
ACD and atopic dermatitis can coexist and certain clinical features can help differentiate ACD from endogenous atopic dermatitis in children. It is important to consider ACD in children with recalcitrant a...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Trends in pediatric skin cancer
Purpose of review
To inform pediatric providers of the clinical characteristics, underlying genetic drivers, and therapeutic options for skin cancer arising in childhood and adolescence.
Recent findings
The incidence of melanoma in pediatric patients has been declining in the past decades. Pediatric-specific diagnostic criteria should be utilized when assessing lesions concerning for melanoma to better account for the different presentations seen in pediatric disease compared with adults, such as an increased prevalence of amelanotic melanoma or frequent mimic of benign pediatric lesions. Pediatric melanoma often pres...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Pediatric nail disorders: a review
Purpose of review
Nail disorders represent an uncommon subset of complaints seen in pediatric dermatology. There is a wide array of disorders that can affect the nail unit in children, including infectious, inflammatory, neoplastic, congenital, and traumatic processes. In order to enhance familiarity with pediatric nail conditions, we review the background and treatment of the more common entities seen in pediatric onychology, including onychomycosis, onychomadesis, nail psoriasis, trachyonychia, longitudinal melanonychia, onychophagia, and onychocryptosis.
Recent findings
Nail involvement in pediatric patients with p...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Hemangioma-related syndromes
Purpose of review
There is a growing understanding of complications and anomalies associated with infantile hemangiomas. The current review will discuss recent clinical advances in syndromes associated with segmental hemangiomas, including PHACE and LUMBAR syndrome. In addition, the importance of recognizing visceral hemangiomatosis is highlighted.
Recent findings
Ongoing longitudinal studies of PHACE and LUMBAR syndromes associated with segmental infantile hemangiomas have led to improved diagnosis and recommendations for screening for associated anomalies. Characterization of a growing spectrum of associated anomali...
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
Congenital melanocytic nevi
Purpose of review
To update pediatric providers on new developments in our understanding of the clinical presentation, genetics, and systemic risks associated with congenital melanocytic nevi (CMN).
Recent findings
CMN are primarily caused by sporadic postzygotic somatic mutations, most frequently in NRAS, and studies of the genetic underpinnings of CMN have demonstrated a diverse array of genetic drivers. The primary complications of large and giant CMN include neurocutaneous melanocytosis and malignant melanoma. Abnormalities in CNS MRI may predict a worse clinical course for patients and increased risk of melanoma....
Source: Current Opinion in Pediatrics - July 30, 2020 Category: Pediatrics Tags: DERMATOLOGY: Edited by Albert C. Yan Source Type: research
