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. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

Articles

This week, take a look at several video interviews with experts from the 2024 AAP meetings, all in one place. 

Weekly review: Expert interviews from the 2024 AAP National Conference & Exhibition

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

Kay Rhee, MD, discusses the challenges of pediatric obesity treatment, highlighting the role of biological and environmental factors, behavioral interventions, and the potential benefits of GLP-1 medications in weight management for children and teens.


Overcoming pediatric obesity: Behavioral strategies and GLP-1 support

At the 2024 AAP National Conference, Steven Selbst, MD, highlighted the rise in accidental THC ingestions among children, urging pediatricians to counsel parents on the dangers of improperly stored THC gummies that resemble candy.

Trend talk: Increasing THC ingestions in pediatric emergency departments

Angela Chun, MEd, MD, FAAP, shares tips on distinguishing mechanical vs inflammatory joint pain in children, emphasizing timing, activity, and key physical exam maneuvers.

Angela Chun, MEd, MD, FAAP, identifies red flags in pediatric joint pain

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Headaches are common in children, but not all headaches are the same. This article offers a review of triggers and treatments.

Children and headaches: Red ­flags, triggers, and rescue treatments

Tanya Altmann, MD, discusses the growing issue of childhood obesity in the United States and the benefits of new weight management medications.

Tanya Altmann, MD, discusses childhood obesity, lifestyle changes, and medications

At the 2024 American Academy of Pediatrics (AAP) National Conference & Exhibition, Tanya Altmann, MD, a UCLA-trained pediatrician and AAP spokesperson, discussed the growing problem of pediatric obesity in the United States. With the increasing availability of weight management medications, including some groundbreaking treatments, Altmann—editor-in-chief of AAP's books, Caring for Your Newborn and Young Child: Birth to Age 5 and Your Baby’s First Year—hared her evolving perspective on how these new options can transform care for children struggling with obesity. 

"As we know, obesity is a huge problem, growing problem in the United States, and we now have more tools, the weight management medications that we can begin using for kids and families who really need it," said Altmann. Initially hesitant about these medications, she explained that after hearing from pediatricians and endocrinologists who have successfully used them, she has come to recognize their potential. "I do really feel it can be a life-changing tool for these families," she emphasized. 

Altmann highlighted the ongoing importance of lifestyle interventions, stating, "We need them outdoors, exercising. We need them eating healthy, nutrient-rich meals. We need them not spending time on screens." Despite these efforts, she noted that many families are doing everything right, yet some children continue to struggle. "There is this group of kids where they are just constantly thinking about food, and it's really overwhelming and detracts from their school, from their self-confidence," she explained. 

The availability of weight management medications, such as semaglutide, has provided a critical new tool for these families. Altmann observed that the effects can be profound: "It really helps those kids no longer be completely focused on what their next meal and snack is, and they're not constantly hungry." As a result, children are able to focus on other aspects of their lives, including school and self-care. "They are able to focus more on eating a balanced meal with the rest of the family, exercising, they're more self-confident, they can focus more in school and do better," she shared. 

in May of 2024, the amount of adolescents and young adults receiving GLP-1 receptor agonists including semaglutide (Ozempic) and tirzepatide increased approximately 6-fold from 2020 to 2023.

The US Preventive Services Task Force (USPSTF) ultimately recommended

 comprehensive, intensive behavioral interventions for children and adolescents aged 6 years and older with a high body mass index in June 2024. The USPSTF reviewed pharmacotherapy to address high BMI in youth, as 4 medications (orlistat, liraglutide, phentermine/topiramate, and semaglutide) are currently FDA approved to treat long-term obesity in adolescents aged 12 years and older.

In a review of 8 clinical trials, All medications demonstrated increases in the likelihood of losing 5% and 10% of baseline weight or BMI, however, the USPSTF determined "the totality of the evidence was found to be inadequate," noting that only a single trial for each medication lasted longer than 2 months.

Altmann concluded by stressing that while these medications are not a cure-all, they represent a valuable addition to the tools available for pediatricians and families. "There’s not just one thing that is going to really help these families, but it's another tool now, that missing piece that we didn't have before for those families that were listening to their pediatricians and doing everything else as they should be." 

This combination of lifestyle changes and new medical therapies may offer a more comprehensive solution to the complex challenge of pediatric obesity. 

1. Kunzmann, K. Adolescent GLP-1 prescriptions increased 6-fold from 2020 to 2023. 

. May 23, 2024. Accessed October 2, 2024. https://www.contemporarypediatrics.com/view/adolescent-glp-1-prescriptions-increased-6-fold-2020-2023

2. Fitch, J. USPSTF recommends intensive behavioral interventions for children with high BMI. 

. June, 18, 2024. Accessed October, 2, 2024. https://www.contemporarypediatrics.com/view/uspstf-recommends-intensive-behavioral-interventions-for-children-with-high-bmi

Tanya Altmann, MD, discusses the growing issue of childhood obesity in the United States and the benefits of new weight management medications. 

News

At AAP 2024, Rana Hamdy, MD, shared insights from her session, "Diagnosis and Treatment of Community-Acquired Pneumonia." 

Rana Hamdy, MD, talks diagnosis, treatment of community-acquired pneumonia

At the 2024 American Academy of Pediatrics National Conference & Exhibition, Rana Hamdy, MD, a pediatric infectious diseases physician at Children’s National Hospital in Washington, D.C., provided key insights into the management of community-acquired pneumonia (CAP) in children. Speaking to an audience primarily composed of primary care pediatricians, Hamdy emphasized the importance of incorporating new evidence into clinical practices, even though official guidelines are still based on recommendations published over a decade ago.

“I was honored to be invited by the conference organizers specifically to talk about CAP,” said Hamdy. CAP, she explained, is a common condition encountered by pediatricians in both outpatient and inpatient settings, which makes staying up-to-date with the latest research essential.

“The most recent consensus guidelines for the management of CAP in children published by the IDSA in kids were published in 2011, so it’s been 13 years,” she noted, highlighting the gap between guidelines and current evidence. 

“For the diagnosis and management of CAP in preschool-age children, so children under 5 years old, the vast, vast, vast majority of those are viral, and the recommendations remain watchful waiting without antibiotics for those children,” she explained. This approach prevents the unnecessary use of antibiotics, which can lead to resistance. “The prior guidelines from 2011 recommend that X-ray is not necessary to make the diagnosis, and that in the outpatient setting, specifically for mild CAP, that diagnosis can be made clinically,” Hamdy said. However, she acknowledged the difficulty of clinical diagnosis due to overlapping symptoms. 

Hamdy also introduced the audience to newer tools for diagnosing CAP, such as the pneumonia risk score, which helps clinicians assess the likelihood of pneumonia. “There are additional clinical tools that have been proven to be superior to just clinician Gestalt in trying to diagnose pneumonia, and one of them is called the Novel Pneumonia Risk Score,” she said. This tool incorporates clinical information such as age, temperature, oxygen saturation, and exam findings to guide next steps in diagnosis and treatment, Hamdy said.  

When it comes to antibiotic therapy, Hamdy stated updated research has supported shorter course of treatment.

"[Since 2011], there have been several high quality randomized control trials comparing the duration of antibiotic therapy 5 days compared to 10 days," Hamdy said. "During that 5 days of high dose amoxicillin is just as good as 10 days, and in fact, leads to fewer adverse drug related events and antibiotic resistance with similar clinical outcomes with regard to treatment failure. So really, 5 days should be reflected in updated guidelines, and so even though the 2011 guidelines don't say that, we do have evidence supporting that 5 days is appropriate therapy."

Click here for more coverage from the 2024 AAP National Conference & Exhibition.

At AAP 2024, Rana Hamdy, MD, shared insights from her session, "Diagnosis and Treatment of Community-Acquired Pneumonia."

Influenza Vaccine Live (FluMist; AstraZeneca) is now FDA approved for the prevention of

caused by subtypes A and B for self- or caregiver-administration among individuals aged 2 to 49 years, according to an announcement from the federal agency.

Initially approved for use in 2003 for individuals aged 5 to 49 years, the FDA approved use of the nasal vaccine in children as young as 2 years of age in 2007. 

FluMist, which still requires a prescription, contains a weakened form of live influenza virus strains that are sprayed in the nose. With the updated indication, the vaccine may be administered by a health care provider in a health care setting (including a pharmacy) or it may be administered by the vaccine recipient or a caregiver who is 18 years of age or older, the FDA stated.

Tina Tan, MD, FAAP, FIDSA, FPIDS, Professor of pediatrics, Feinberg School of Medicine, Northwestern University; pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago, told 

 this expanded indication should help boost vaccination rates, though there are limitations.

"This intranasal live attenuated vaccine has been around for years as an option for influenza vaccination but utilization of the vaccine has been less than expected," Tan said. "It can only be given to healthy individuals 2 to 49 years of age with no underlying conditions, including asthma. Making it available for in home use should increase the use of this vaccine and influenza vaccine, however, it will be important that the selling of this vaccine be monitored as you do not want the wrong individuals receiving the vaccine." 

Tan added caution and attention to instruction for FluMist for self- or caregiver-administration should be taken, and that when available, the vaccine should help those weary of needles. 

"There will need to be clear instructions as to what should be done if the person does not receive the entire dose given that this is a nasal spray, but there is some volume to it, so parts of the dose could drip out of the nose," Tan said. "In home vaccine is not available this influenza season but is expected to be available next influenza season. It's definitely an option for needlephobic individuals."

"Today’s approval of the first influenza vaccine for self- or caregiver-administration provides a new option for receiving a safe and effective seasonal influenza vaccine potentially with greater convenience, flexibility and accessibility for individuals and families,” said Peter Marks, MD, PhD, in a press release from the FDA.

Marks is the director of the FDA's Center for Biologics and Evaluation and Research. "This approval adds another option for vaccination against influenza disease and demonstrates the FDA’s commitment to advancing public health.”

The common and contagious respiratory disease typically circulates during the fall and winter seasons in the United States. Per the Centers for Disease Control and Prevention (CDC), influenza has resulted in about 9.3 million to 41 million illnesses, 100,000 to 710,000 hospitalizations and 4,900 to 51,000 deaths annually between 2010 and 2023. 

Several vaccines approved by the FDA are available during the traditional influenza season, including those 

recommended by the CDC and the Advisory Committee on Immunization Practices (ACIP).

Fever over 100°F in children 2 through 6 years of age, runny nose and nasal congestion in individuals 2 through 49 years of age, and a sore throat in adults 18 through 49 years of age are the most commonly reported side effects of FluMist, according to the FDA. 

The agency noted that those interested in self- or caregiver-administration can expect the vaccine to be available via a third-party online pharmacy, and those who choose this option will complete a screening and eligibility assessment when they order FluMist. 

Caregivers should administer FluMist to individuals aged 2 to 17 years, "as individuals in this age group should not self-administer the vaccine," the FDA stated.

FDA Approves Nasal Spray Influenza Vaccine for Self- or Caregiver-Administration. FDA. Press release. September 20, 2024. Accessed September 20, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-nasal-spray-influenza-vaccine-self-or-caregiver-administration?utm_medium=email&utm_source=govdelivery

With this approval, FluMist becomes the first vaccine to prevent influenza that does not need to be administered by a health care provider. 

FDA approves FluMist for self- or caregiver-administration

It is no secret pediatricians play an unequivocally important role in effectively promoting healthy, active living through direct care, advocacy, and multiple forms of support.

 With growing responsibilities, lack of access to specialty care, and burnout, finding additional tools to help deliver the high standard of care for which pediatricians aim can only help.

When it comes to mental health issues among the pediatric population, digital therapeutics could help make a positive impact. According to Jason Kahn, PhD, researcher at Boston Children’s Hospital, instructor of psychiatry at Harvard Medical School, and chief scientific officer and founder of the Mightier digital therapeutic, these tools can be a stop-gap until specialized care is available. 

“I think a lot of pediatricians will be familiar with a lot of the core of the problem that's going on with kids and adults, but kids especially, which is access,” Kahn said. “We don't have a lot of psychiatrists, psychologists, even clinical social workers who can keep up with the demand that we are seeing when we look at kids with ADHD, anxiety, autism, depression, or any number of conditions that we’re seeing. All these prevalence rates are going up. Where digital therapies can step into the void if they can provide tools so kids can build skills, competencies, and strengths that can help them succeed and thrive while they are potentially on a waiting list for more specialized providers, these skills can then transfer into their lives. With these tools, we see kids having more success and getting help earlier when available.”

But what are digital therapeutics? They are technologies such as video games, that are designed to help overcome some limitations seen with conventional mental health care to reduce the risk of further development of these problems. According to a 2022 study published in 

, investigators noted these limitations can include limited access to specialty care, lack of intervention engagement, and unsustainable treatment effects. These digital therapies are developed to demonstrate “therapeutic effects on targeted mental health problems,” stated the investigators.

Kahn, founder of Mightier—a digital therapeutic that targets emotional regulation to help the child maintain the ability to think and keep control while playing video games built inside the device—explains why background and data are important aspects of digital therapeutics, and how Mightier works. 

“A digital therapeutic should be able to tell your patient, or the pediatrician, the evidence, what the target is, what the age is, how it's going to improve, and expectations for dosage. When all those parts play out, we should be able to say, 'this is what we expect when a kid is exposed to this,’” said Kahn. “For me, a digital therapeutic is something where the evidence is really well understood and we can put that in patients' hands, or kids’ hands in my case, and see some well-understood benefit.”

“The way Mightier works itself is that it's built on top of video games. Kids wear a heart rate monitor while they play, [which] allows us to take the moments of frustration that happen in the video game and then start to give kids feedback during those moments of frustration so they see themselves facing a challenge. Then they see their body change in the context of that challenge,” Kahn said in an interview with 

“Rather than just end there, we give the kid a course of action,” he added. “What we do to the game itself is a little counterintuitive to adults because we make the game harder. The child wants to be successful and they understand the language of a game, so they say, [theoretically], 'my body's an input. My emotions are an input. I'm going to be now incentivized to figure out a way to cool down.' We're also giving the kids help as they do this. We're showing them deep breathing exercises. We're showing them progressive muscle relaxation. A bunch of tools that they would be getting in a therapy office we're giving them so they understand what will help their body calm down at the moment, and we watch this progression as kids go through.” 

Kahn added that repetition is a key part of digital therapeutics, as the child can demonstrate over time how their frustration, focus, and body changes. This data is then used to transition the process into other aspects of the child’s life. 

“At the beginning, when they start Mightier, they use these resources, tools, they take the hints that we give them, and they'll use that to cool their body down,” he said. “As they do hundreds, if not thousands of these repetitions because it's a video game, it happens a lot and happens fast, they start becoming more automatic and more self-directed on how to cool down their body. That's the dream, right? We can see that transition in the game, and then we do have data that connects it and takes it from the game. Watching these kids become successful is really what we hope for.”

A 2021 proof of concept randomized controlled trial (NCT 01551732) that featured Mightier, referred to as Regulate and Gain Emotional Control (RAGE-Control) in literature works, was published in 

 Investigators, including Kahn, compared reduction in aggression, anger, oppositionality, and global severity between 2 treatment conditions, which were Anger Control Training (ACT) augmented with Mightier and ACT with a sham version of the game. Heart rate during gameplay was monitored and examined to explore associations between symptom changes and heart rate changes.

There were 40 youths with clinically significant anger dyscontrol aged 10 to 17 years included in the trial, which was conducted at Boston Children’s Hospital between July 2011 and February 2013. According to the investigators, the sample size was determined by power analysis, targeting 80% power to detect effect sizes (ES = 0.63–1.68) from a prior, preliminary, open-label study. Individuals were assigned randomly to 10 sessions of ACT with Mightier (n = 20) or ACT with the sham video game (n = 20). In the first 5 sessions, patients learned a specific coping skill to regulate their mood and behavior, then spent 15 minutes playing Mightier or the sham version of the game, during which they were instructed to use the previous coping skill learned. In sessions 6-10, structured problem solving was involved, “applying coping skills to real-life current problems and continued practice with the assigned version of RAGE-Control,” wrote the authors.

Results demonstrated that both treatments similarly reduced self-reported anger, but mightier treatment led to larger improvements in aggression (CI: –17 to –1.0, ES: 0.55, 

 = 0.015), oppositionality (CI: −9.0 to −7e-6, ES: 0.48, 

 = 0.032), and global severity (CI: −1.0 to −5e-6, ES: 0.51, 

 = 0.023) compared to the sham video game. Participants using Mightier also experienced larger pre-to-post decreases in heart rate, which was significantly associated with larger pre-to-post decreases in aggression and oppositional behaviors.

“Emotional regulation is this ability when you are frustrated, when you have hot emotions, to sort of maintain your cool, maintain your ability to think and stay present and then be successful,” Kahn said. “We see emotional regulation on both the deficit side and the strength side. Kids who have neurodevelopmental diseases like ADHD or autism typically have less emotional regulation. It also shows up in anxiety sometimes. On the flip side, we do see that kids who are particularly resilient and particularly successful in social settings tend to have a lot of emotional regulation.” 

Kahn and coauthors of the study concluded that findings supported that augmenting traditional treatment with technology through skill practice can translate to real-life behavioral change and enhancements. Kahn stated awareness of digital therapeutics might be low, and he wants health care providers to know these technologies exist and can help facilitate care.

“We're asking pediatricians to do more and more, and I don't think we've done a great job helping pediatricians understand how the digital mental health landscape is evolving and changing, and what options are available to them,” he said. “Trying to get the word out and have pediatricians understand what these tools are, I think, is one of the biggest challenges, especially in the context of asking pediatricians to be all sorts of people and wear all sorts of hats for the patients coming into their offices.”

Jason Kahn, PhD disclosed the following to Contemporary Pediatrics: 

Board membership - Neuromotion Inc d/b/a Mightier

Employment - Neuromotion Inc d/b/a Mightier

Grants received/research funding - NIH - R44MH124574

1. Muth ND, Bolling C, Hannon T, Sharifi M. The role of the pediatrician in the promotion of healthy, active living. 

. March 2024; 153 (3): e2023065480. 10.1542/peds.2023-065480

2. Zarefsky M. Most pediatricians have burnout. Here’s what it takes to fix that. American Medical Association. January 8, 2024. Accessed August 8, 2024. https://www.ama-assn.org/practice-management/physician-health/most-pediatricians-have-burnout-here-s-what-it-takes-fix

3. Choi E, Yoon EH, Park MH. Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions. 

. 2022;13:986687. doi:10.3389/fpsyt.2022.986687

4. Ducharme P, Kahn J, Vaudreuil C, et al. A “proof of concept” randomized controlled trial of a video game requiring emotional regulation to augment anger control training. 

. 2021;12:591906. doi:10.3389/fpsyt.2021.591906 

Digital therapeutics help kids build emotional regulation and coping skills, supporting pediatric care while waiting for specialized mental health services.

Susy Jeng, MD

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