Best practices for pediatricians in diagnosing and treating asthma

Additionally, they can treat atopic comorbidities such as atopic dermatitis, chronic urticaria, nasal polyps, eosinophilic esophagitis, and hypereosinophilic syndrome, resulting in improved quality of life for our patients. Parents should be made aware of its updated black box warning for possible effects on mental health and behavior changes,3 including but not limited to suicidal ideation. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair);advises restricting use for allergic rhinitis.

Best practices for prescribing medication

Anxiety and depression were relatively common in children and adolescents before the COVID-19 pandemic1;not surprisingly, study findings suggest that these conditions' prevalence has increased.2 Typical support systems for children and adolescents-friends, family, school, and extracurricular activities-look much different during the current pandemic. There are many misconceptions about psychotropic medications and stigmas because of mental health problems in general. National organizations such as the American Academy of Pediatrics and the American Association of Child and Adolescent Psychiatry have developed resources to help pediatricians feel more comfortable with offering mental health care, and groups such as The REACH Institute offer postgraduate training programs that provide education and ongoing support.

Assessment and treatment of eating disorders in adolescents

Pediatric health care providers understand that eating disorders are not lifestyle choices but lifethreatening mental health conditions Among patients of all ages, anorexia nervosa (AN) has the second-highest mortality rate of all mental health conditions, after substance abuse.1 Both suicide and the physical effects of nutritional deficit are implicated. Prevalence Analyses of prevalence vary widely in their findings.2 One meta-analysis found lifetime prevalence of AN from 1.7% to 3.6% for female patients and 0.1% for male patients;lifetime prevalence of BN for female patients was about 2.1%.3 BED, with reported prevalence rates of approximately 2% to 4%, is almost as common among male as female patients.2 4 Among adolescents aged 13 to 18 years, one study found prevalence rates of 0.3% for AN, 0.9% for BN, and 1.6% for BED.5 Long characterized as affecting primarily affluent White adolescent girls, eating disorders now affect people from lower socioeconomic groups, members of non-White ethnic groups, preteen children, and boys.2 LGBTQIA+ young people may be at particular risk.6 During the early months of the COVID-19 pandemic, hospitalizations for eating disorders doubled,7 and patients reported significant increases in unhealthy behaviors.8 Screening Caregiver reports about a child's weight or eating habits or clinical observation of unexpected weight changes are likely to alert the pediatrician to the possibility of an eating disorder. Presence of any one of the following symptoms indicates the need for immediate medical hospitalization for refeeding2'14: O Heart rate less than 50 beats per minute (bpm) while awake;less than 45 bpm while asleep O Systolic pressure less than 90/45 mm Hg O Orthostatic changes: decrease in blood pressure of more than 20 mm Hg systolic or 10 mm Hg diastolic;heart rate increase of more than 20 bpm O ECG abnormalities: Prolonged corrected QT interval or other arrhythmia O Syncope O Temperature less than 96 °F (35.6 °C) O Electrolyte abnormalities O Uncontrollable binge eating and purging Dehydration Suicide risk O Less than 75% of expected body weight O Failed outpatient management O Acute weight loss and food refusal Communication Today's young people typically know what anorexia and bulimia are.