Pediatric Anxiety Disorders: When to Worry About Worry.

Anxiety is incredibly common and even normal as a waxing and waning dominant emotion for children. However, attention to disruptive symptoms that prevent daily functioning or prevent a child from thriving is within the purview of the general pediatric medical home. We review diagnosis, current tools readily accessible to every pediatrician, and treatment approaches, with special sensitivity to pandemic-related barriers and outcomes related to pediatric anxiety disorders. More than ever, the general pediatrician should be prepared to co-manage anxiety disorders with an interprofessional mental health team. [Pediatr Ann. 2021;50(11):e446-e448.].

The Tattle About Tongue-Ties.

Ankyloglossia, commonly called "tongue-tie," has been increasingly diagnosed in the breast-feeding infant, with growing numbers of surgical interventions in the last 2 decades. As more practitioners have become involved in the diagnosis and treatment, there has not been a consensus on terminology and indications for intervention. In 2020, the American Academy of Otolaryngology - Head and Neck Surgery Foundation reviewed the bodies of lactation, dental, pediatric, and otolaryngology literature to seek professional consensus and note areas requiring more definitive evidence. This article highlights the findings for the general pediatrician seeking to support breast-feeding dyads. [Pediatr Ann. 2021;50(8):e310-e312.].

Accounting for General Anesthesia: A Pre-Op Primer and Post-Op Factor.

Infants and young children are in a period of rapid neurodevelopment, making them more vulnerable to neurotoxic agents. A topic of much debate is how persistent and pervasive cognitive delays are for children exposed to anesthesia at a young age. The US Food and Drug Administration issued a warning in late 2016 calling for providers to share information about such risks with families before any medical interventions requiring use of anesthetics. This article offers the pediatric generalist some background on the warning and tips for counseling families before a procedure as well as reminders for surveilling beyond a procedure. [Pediatr Ann. 2021;50(5):e187-e189.].

Facial Recognition: More Than Just a Phone Problem.

Mask-to-mask encounters are the norm in every health care setting these days. In some ways, as everyone is forced to develop communication strategies for building rapport without the benefit of friendly smiles, our job as pediatricians communicating with children and parents is no more difficult than for everyone else. However, pediatricians are a special kind of physician who generally hone nonverbal communication skills early in our training, and the face is one of the earliest developmental social cues in infancy. Furthermore, especially in the medical home, it is our privilege and duty to foster a sense of safety and confidence in seeking medical care. In this column, we review what the current research has to say about the impact of masks on physician-patient relationships and communication, as well as the science of other nonverbal communication strategies and social cues. [Pediatr Ann. 2021;50(2):e52-e54.].

Simulation in Pediatrics: A Learning Lab for Education, Quality Improvement, and Patient Safety.

Simulation-based medical education is an experiential modality that has evolved over the last 60 years, amassing evidence as an efficacious tool for skill acquisition and care improvement. We review the underlying theory, core defining principles, and applications of medical simulation broadly and in pediatrics in hopes that it can be accessible to every pediatric clinician regardless of practice environment and resources. Any situation where there is risk of harm to a patient or clinician can be simulated for practice, reflection, and re-practice. Whether preparing for clinic-based emergencies, new hospital units, or new daily workflows, simulation is valuable to novice and master clinicians for individual and team care enhancement. [Pediatr Ann. 2021;50(1):e13-e18.].

Screening for Healthy Screen Time.

Beyond leisurely entertainment, screen time is now an inevitable part of childhood, especially during a pandemic that has shifted learning and socializing into virtual environments. Families helping children develop safe and healthy relationships with screen-based media need information about how to reap the most benefits while understanding ways to mitigate risks to visual, metabolic, and socio-emotional health. [Pediatr Ann. 2020;49(11):e452-e454.].

Reflux: When Is It More Than a Laundry Problem?

Despite growing cautionary evidence against routine pharmacologic management of infant reflux, proton-pump inhibitors and H2-receptor antagonists are regularly asked for and prescribed at pediatric well-visits in the first year of life. It is important to distinguish between physiologic gastroesophageal reflux and gastroesopheal reflux disease, even though the symptoms can seem interchangeable and overlap with other normal developmental phenomena and common conditions, such as cow's milk protein intolerance. Careful history, ample anticipatory guidance, and nonpharmacologic intervention should be attempted before consideration of acid suppression therapy in the first year of life. If the general clinician feels medication is warranted in the absence of clear indicating medical comorbidities, consultation with a pediatric gastroenterologist should be considered. [Pediatr Ann. 2020;49(8):e329-e331.].

Pacifiers: A Cause for Confusion.

Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].

The Care of the Infant Being Placed for Adoption.

Adoption in the United States is a way for families to grow, and pediatricians will invariably take care of infants being placed for adoption. Reasons why an infant will be adopted are highly variable, as are the types of relationships that birth parents have with their infants. Care of the infant being placed for adoption in the nursery involves close attention to detail to ensure appropriate continuity of care and information as the infant transitions into their eventual medical home. Adoptive parents often seek additional information from their child's health care providers, and pediatricians should be equipped to provide guidance both prior to and after the adoption process. Office-based pediatricians should support adoptive parents with a longitudinal approach informed by best practices and principles of well-child care. [Pediatr Ann. 2020;49(2):e61-e63.].

New Onset Autoimmune Disease or Macrophage Activation Syndrome?

Macrophage activation syndrome (MAS) is a potentially life-threatening condition that may complicate many pediatric rheumatologic diseases. Because of its similarity in presentation to other conditions with overlapping manifestations, such as flares of rheumatologic disease or systemic infection, and the fact that there exists no single pathognomonic clinical finding or laboratory parameter to aid in diagnosis, MAS presents a significant diagnostic challenge to the practicing pediatrician with limited access to consulting pediatric rheumatologists. Along with a review of the physiology and manifestations of the condition, we have included the most current consensus for diagnosing MAS. [Pediatr Ann. 2019;48(10):e395-e399.].

When the Great Masquerader Reveals Itself-Tuberculosis.

Pneumonia is a clinical diagnosis often treated empirically and successfully on an outpatient basis. When a patient fails to improve, the clinician is left to revisit the differential of pathogens and reconsider the host. Admission, imaging, and invasive and noninvasive testing are part of the toolkit for the severe or atypical case of pneumonia. For fastidious organisms, achieving a culture-proven diagnosis can be quite difficult. This article discusses the screening and testing for tuberculosis, reviews the utility of computed tomography imaging and bronchoscopy with bronchoalveolar lavage in severe or atypical pneumonia, and highlights the barriers to definitive diagnosis even when the causative microbe is on the differential diagnosis when a patient is admitted. [Pediatr Ann. 2017;46(2):e51-e55.].