{"title":"Medically Unexplained Symptoms","authors":"Ariana Martin","doi":"10.1542/aap.ppcqr.396501","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396501","url":null,"abstract":"\u0000 Medically unexplained symptoms (MUS) may include pain, fatigue, or urinary, cardiovascular, rheumatologic, or gastrointestinal concerns.Medically unexplained symptoms are often associated with mental health problems, especially with anxiety and depression. Only a small minority of MUS are due to unrecognized physical disease.Assess for physical conditions, yet avoid unnecessary medical tests.Review symptom characteristics and their effect on functioning.Consider using screening tools to help clarify the diagnosis (eg, general psychosocial screening tools, Children’s Somatization Inventory, Functional Disability Inventory).Include the diagnosis of somatic symptom and related disorders from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, in the differential diagnosis, not merely as an excluded diagnosis.Intervention by the pediatric clinician can include all the following steps:Empathetically acknowledging distress caused by MUSReaching agreement with the patient and family on incremental steps toward improving functioning and addressing co-occurring mental health concerns and improving the family’s mental health generally (see General Treatment Approach: Universal Strategies to Reinforce Strengths and Promote Emotional Health Within Families\")Encouraging the family to reinforce healthy behaviors and minimize secondary gainConveying optimism that distress will decrease with interventionEducating the patient and familyCoordinating with other clinicians involved in the child’s care to prevent unnecessary attention to physical concerns and costly, intrusive workupsWhen severe impairment occurs, refer to mental health professionals for evidence-based therapy and ensure treatment of co-occurring mental health conditions.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"270 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120980101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perinatal Depression","authors":"","doi":"10.1542/aap.ppcqr.396503","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396503","url":null,"abstract":"\u0000 Perinatal mood and anxiety disorders affect 15% to 20% of mothers from conception to 1 year postpartum and 4% to 25% of fathers.Infants of affected mothers are at risk for impaired social interaction, delays in language and cognitive development, failure to thrive, reactive attachment disorder of infancy, early discontinuation of breastfeeding, and neglect and abuse; longer-term adverse effects can be seen in the child’s learning, memory, behavioral, and emotional adaptation.Formal screening for perinatal depression at infant preventive visits, consistent with the peaks of occurrence, is recommended by Bright Futures, 4th Edition; US Preventive Services Taskforce (2016); and Centers for Medicare & Medicaid Services (2016).Caregivers with a positive screen result and/or symptoms of depression should be triaged for a psychiatric or social emergency and their infants should be screened and followed for potential social-emotional problems.Management is 2-generational.For the parents, demystification, brief interventions to promote the mother-infant relationship and encourage social connections, and referral for evidence-based therapy (individual or couple), emergency medical services, or hospitalizationFor the child, regular monitoring of social-emotional development and Early Intervention Part C servicesFor the mother-infant dyad, evidence-based therapy by a pediatric mental health specialist with expertise in treating infants and young children (0–5 years of age).","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115626945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emotional or Behavioral Problems in Children Younger Than 5 Years","authors":"","doi":"10.1542/aap.ppcqr.396500","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396500","url":null,"abstract":"\u0000 Symptoms suggesting social-emotional or behavioral problems in children younger than 5 years may occur inThe child (eg, irritability, fearfulness, dysregulation, difficulty adjusting to childcare or preschool)The caregiver (eg, negative attributions about child, unable to offer comfort, disengaged or excessively protective)The relationship between the child and caregiver (eg, lack of social reciprocity or focused attachment)Early identification requires surveillance for environmental risks, strengths, and adversities; formal psychosocial screening of the child and primary caregiver using validated tools; and observations of the child and caregiver(s).Assessment involves differentiating positive findings from normal variations, considering medical and developmental problems that may mimic or co-occur with social-emotional or behavioral disturbances, evaluating the caregiving environment(s), reviewing diagnostic criteria of disorders (DC:0–5; Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood), and, as indicated, referring the child and/or caregiver to an appropriate specialist.Pediatric clinicians can use \"common factors\" communication techniques to reinforce child and family strengths and reach agreement on achievable steps towardAddressing social adversitiesEncouraging healthy habits and activitiesOvercoming barriers to specialty referral for diagnostic evaluation and evidence-based therapy—recommended for any child/caregiver dyad with impairing symptomsWhile awaiting specialty services, pediatric clinicians can apply common elements of effective therapy: reduce family stress, promote positive parent-child interactions, coach in positive parenting principles, and teach relaxation and anxiety management.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116158079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dysmenorrhea","authors":"","doi":"10.1542/aap.ppcqr.396063","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396063","url":null,"abstract":"\u0000 Dysmenorrhea (ie, painful menses) is a frequent cause of school absenteeism in girls.Primary dysmenorrhea typically occurs 1 to 2 years after menarche.Common causes of secondary dysmenorrhea including sexually transmitted infections (STIs), pelvic inflammatory disease, endometriosis, outflow tract obstruction, and endometrial polyps or fibroids.A careful history and physical examination are sufficient to diagnose primary dysmenorrhea.Secondary dysmenorrhea may require additional evaluation, including STI testing, imaging studies, and referral to a specialist.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125128675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"High Altitude Illness","authors":"Jaci R. Taylor","doi":"10.1542/aap.ppcqr.396463","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396463","url":null,"abstract":"\u0000 Individuals traveling to high altitudes (usually to ≥2,500 m) are at risk of developing high altitude illness (HAI), especially if ascending quickly.Acclimatization and slow ascent are the most effective ways to avoid HAI.Acetazolamide is prevention and treatment.High altitude illnesses typically respond to descent, oxygen therapy, or both.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133316847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lymphadenopathy","authors":"","doi":"10.1542/aap.ppcqr.396093","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396093","url":null,"abstract":"\u0000 Palpable cervical, occipital, and inguinal lymph nodes are common in healthy children.Important to distinguish reactive from infiltrative and localized from generalized adenopathyKnowing which group of lymph nodes drains which area(s) of the body helps direct diagnostic evaluation. Character of enlarged node(s) also helps guide evaluation: tenderness, warmth, fluctuance, hardness, fixation.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116669552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gastroesophageal Reflux Disease","authors":"S. Mattioli","doi":"10.1542/aap.ppcqr.396164","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396164","url":null,"abstract":"\u0000 Gastroesophageal reflux (GER) is a normal physiological process that entails relaxation of the lower esophageal sphincter, independent of swallowing.Gastroesophageal reflux disease (GERD) is frequent, persistent, and troublesome symptoms associated with GER, leading to complications or sequelae or complications associated with GER.GER is prevalent in the first 5 months after birth; most cases resolve by 12 to 14 months of age, and almost all by 24 months of age.No single criterion standard test or testing approach allows a definitive diagnosis of GER or GERD.Diagnosis of reflux disorders is generally based on a description of symptoms in the absence of alternative diagnoses.Many diagnostic modalities can be used in a thoughtful and serial manner to provide specific information about the cause and severity of acid reflux and to investigate for associated or alternative conditions.Management of GER/GERD involves lifestyle modifications, buffering agents, acid suppression, promoters of gastric emptying, and motility.Surgical therapy is reserved for children at risk for significant life-threatening complications of GERD.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"629 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116405471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vaginal Bleeding","authors":"","doi":"10.1542/aap.ppcqr.396121","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396121","url":null,"abstract":"\u0000 Abnormal uterine bleeding refers to bleeding that is excessive or occurs outside normal cyclic menstruationAnovulatory uterine bleeding is the most common cause of abnormal uterine bleeding adolescents within 1–2 years of menarche.It is important to exclude pregnancy and infections prior to initiating treatment for anovulatory bleedingGoals of management for abnormal uterine bleeding include return to pattern of normal menstrual cycle and prevention of anemia.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"382 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123410850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fever of Unknown Origin","authors":"Suchkov Av, Komarov Fi","doi":"10.1542/aap.ppcqr.396074","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396074","url":null,"abstract":"\u0000 Children with fever of unknown origin generally do well, even if the fever persists beyond 2 weeks.Among children, most cases of fever of unknown origin are caused by infections that are usually self-limited or treatable.Thorough history and examination are the most important tools of evaluation.Given how common “fever phobia” is, careful explanation and reassurance are key to management.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128871682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hematuria","authors":"","doi":"10.1542/aap.ppcqr.396080","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396080","url":null,"abstract":"\u0000 The most common cause of hematuria overall is UTI. The most common cause of asymptomatic isolated microscopic hematuria is benign transient hematuria. Before further evaluation, repeating the urinalysis at least once is prudent, and asymptomatic school-aged children may be followed for 2 or more years before further work-up. Macroscopic hematuria is a common sign of glomerular or urologic disease, warranting renal ultrasonography and further evaluation as indicated.","PeriodicalId":396660,"journal":{"name":"Pediatric Care Online","volume":" 546","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141218568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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