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Articles

In a recent study, reductions in body mass index along with further beneficial effects were found when using oral butyrate supplementation for treating pediatric obesity.

Butyrate effective for treating pediatric obesity

At the 44th National Association of Pediatric Nurse Practitioners Conference, drug products abused by teenagers were discussed.

Which drug products are abused by adolescents?

At the 44th National Association of Pediatric Nurse Practitioners Conference, methods of treating atopic dermatitis were discussed.

Treating pediatric atopic dermatitis

At the 44th National Association of Pediatric Nurse Practitioners Conference, pediatric aggression was discussed, including which patients are at greater risk and which management strategies are most appropriate.

Managing aggression in pediatric patients

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Contemporary Pediatrics® Resident Writer Program

Demystifying Infant Formula

Do we take RSV disease seriously enough?

Food Insecurity and the Dangers of Infant Formula Dilution

Getting into the Roots of Childhood Atopic Dermatitis

Opt-Out Chlamydia Screening in Adolescent Care

The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants

Update in Pediatric COVID-19 Vaccines

Clinical

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Clinical Focus

The news is full of stories about monkeypox, the recent changes to COVID-19 guidance, and the return of polio cases. What do clinicians need to know?



 sat down with its editor-in-chief, Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, to discuss the what families can do to prevent polio, the most current information on monkeypox in pediatrics, and the new guidance from the Centers for Disease Control and Prevention on COVID-19.

The news is full of stories about monkeypox, the recent changes to COVID-19 guidance, and the return of polio cases. What do clinicians need to know?

What's going on with polio, monkeypox, and COVID-19

The day after Thanksgiving 2021 the news of a new variant with several mutations was announced and quickly named Omicron, as well as a variant of concern. It has since become the predominant variant causing COVID-19 cases.



 sat down with Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, to discuss what's known about the variant. She also discusses the latest on the vaccine for children aged younger than 5 years.

Contemporary Pediatrics sat down with Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, to discuss what's known about the variant. She also discusses the latest on the vaccine for children aged younger than 5 years.

What Omicron could mean for the pandemic 

The news about the Pfizer/BioNTech COVID-19 vaccine becoming available for children aged 5 to 11 years was met with happiness by pediatricians and many parents alike. Vaccines in the pipeline could bring similar happiness if found safe and effective.



 sat down with editor-in-chief Dr. Tina Q. Tan to discuss the authorization of the Pfizer/BioNTech vaccine for use in many children as well as what lies ahead in the vaccine pipeline for the pediatric population.

Contemporary Pediatrics sat down with editor-in-chief Dr. Tina Q. Tan to discuss the authorization of the Pfizer/BioNTech vaccine for use in many children as well as what lies ahead in the vaccine pipeline for the pediatric population.

What lies ahead for vaccines

The return of cooler temperatures means that the fall/winter respiratory season is nearly here. Last year there was a concerted effort to get the flu shot administered to as many people as possible, what might happen this flu season?

In this episode, 

 sits down with Dr. Donna Hallas, a clinical professor at the New York University Meyers College of Nursing and also a pediatric nurse practitioner, about the upcoming flu season and keeping families safe.

Contemporary Pediatrics sits down with Dr. Donna Hallas, a clinical professor at the New York University Meyers College of Nursing and also a pediatric nurse practitioner, about the upcoming flu season and keeping families safe.

Managing the 2021-2022 flu season

With COVID-19 vaccines available to everyone 12 years of age and older, life in the United States is starting to return to its familiar rhythms, but some families may be left wondering how to keep everyone in the family safe when only some can be vaccinated,



spoke with Andrew J. Schuman, MD, FAAP, about how to help those families remain safe and healthy.

Contemporary Pediatrics spoke with Andrew J. Schuman, MD, FAAP, about how to help families with mixed COVID-19 vaccine status remain safe and healthy.

Helping families navigate a "post pandemic" world

The COVID-19 vaccine offers some challenges for addressing the vaccine hesitant parent. We sat down with Dr. Donna Hallas to discuss how to communicate with parents as well as how to address vaccines missed because of the pandemic.

Contemporary Pediatrics sat down with Dr. Donna Hallas to discuss how to communicate with parents as well as how to address vaccines missed because of the pandemic.

Addressing parental concerns about the COVID-19 vaccine

It's been about a year since the coronavirus disease 2019 (COVID-19) pandemic started in earnest in the United States. A lot has changed in a year and other things haven't changed so much.



 sat down with Andrew J. Schuman, MD, FAAP, about the lessons learned in the pandemic and what his thoughts are about when it might end.

Contemporary Pediatrics sat down with Andrew J. Schuman, MD, FAAP, about the lessons learned in the pandemic and what his thoughts are about when it might end.

The COVID-19 pandemic: One year later 

Dr Anna Mandalakas, professor of pediatrics and tropical medicine at Baylor College of Medicine in Houston, Texas, looks at the 2 screening methods available for latent tuberculosis in children, what the preferred tests have been according to the American Academy of Pediatrics Red Book, and a new study that takes a look at both testing methodologies, to compare efficacy.

Diagnostic Update in Tuberculosis Testing for Children

When the country started shutting down, many were optimistic and thought that people would only have so stay home for a few weeks. During these early days many parents relaxed the screen time and media use rules. However, many children are still at home and remain under those relaxed rules.

Contemporary Pediatrics sat down with Cori Cross, MD, to discuss how families can start to bring back screen time and media use back to pre-lockdown levels. 

Getting back on track with media use

Vaccine hesitancy and vaccine refusal have long been a problem in pediatrics. Last year's measles epidemic served as a signal of what the sentiments could mean for a disease that had been considered vanquished. What could they mean for COVID-19?

 sat down with Andrew J. Schuman, MD, to discuss vaccine hesitancy and how those sentiments could impact the future COVID-19 vaccine.

Contemporary Pediatrics sat down with Andrew J. Schuman, MD, to discuss vaccine hesitancy and how those sentiments could impact the future COVID-19 vaccine.

How vaccine hesitancy could impact the roll-out of the future COVID-19 vaccine

If approved by the FDA, this 5-in-1 investigational candidate could provide the broadest meningococcal serogroup coverage.

Meningococcal ABCWY vaccine meets primary endpoints in phase 3 trial

At the 44th National Association of Pediatric Nurse Practitioners Conference, data was presented on the effectiveness of vaccines and antivirals in preventing life threatening conditions.

How to manage viral infections in pediatric patients

Assessing your knowledge of and performance on preventable diseases. 

What is your meningitis vaccine IQ?

The Omicron variant caused the most symptoms in pediatric patients. However, there were no differences in adverse outcomes by COVID-19 variant.

Pediatric COVID-19 symptoms differed by variant

Children were hospitalized the most during the Omicron variant, but disease outcomes were the least severe during this variant period.

Which COVID-19 variant caused the most severe disease in children?

I think probably one of the most important issues that came up [in 2022] was the mental health crisis that occurred in the pediatric population. The pandemic really had some major effects, especially on adolescents that had underlying anxiety or depression, and really pushed these kids to the edge, where there were many more of these kids that were trying to commit suicide, which I think is just really very sad. But I think because we now recognize that there's so many mental health issues that were brought to light, we really are able to identify these kids and help them.

Other trends that I think were really important in 2022 was the approval of the COVID-19 vaccine for use in infants and children down the six months of age. You know, for a long time, during the pandemic, there was this misinformation that was out there that people believe that either children did not get COVID. Or if they got COVID, they didn't get sick. And we know that's not true. So with the approval of the vaccine, down to six months of age, we are now able to protect so many more of these kids from getting COVID. And we really have to encourage providers to vaccinate their children with the COVID-19 vaccine.

The pandemic really did change the pattern with which the respiratory viruses circulate. We don't really understand why that occurred. But we do know that RSV influenza, even COVID, these surges are occurring much, much earlier than they normally would. And, you know, the RSV surge is very interesting, because there was a surge during the summer, even though it was smaller. And then in October, we started to see a major surge, which, as you said, has really completely strained the pediatric healthcare system. One thing about RSV is that it is a respiratory virus for which the care is really supportive. So the use of antibiotics and the use of albuterol as well as steroids are not really recommended, unless the child is truly having respiratory distress, and they need those drugs for other reasons. But the normal treatment of RSV does not include the use of those agents. The problem is, is that we're also having a surge of influenza COVID-19 is now also starting to increase. And there are a number of other respiratory viruses that are surging at the same time, such as Rhino, enterovirus, adenovirus, para influenza, so it is really made, you know, trying to distinguish which respiratory illness a child has much more difficult. And, you know, we can test for all of these, but you really, you know, because they're viruses, there really is no treatment for them. And the problem is, is that when some of these kids and infants present to say, in an emergency room that's not pediatrics, or to an urgent care or a Minute Clinic, many people, you know, take a look at them. And they think, Oh, my gosh, you know, are they going to develop a bacterial infection. And this has really led to the shortage of antibiotics, because many of these kids are being placed on antibiotics unnecessarily.

The other thing that has really led to kind of a shortage in the pediatric beds situation is that many community hospitals during the pandemic closed down their pediatric units completely, primarily because they felt that they would make more money serving the adult population and not the pediatric population. And this has really led to a bed shortage in many areas where, you know, the Community Hospital is the only hospital that is close by for these kids to be evaluated in. So the vaccine that will be licensed first is a maternal vaccine, meaning that it would be pregnant women, probably between 24 and 36 weeks gestation, that would be getting this vaccine. And what we know from the phase 3 clinical trials, the data that was released, is that this vaccine is very, very effective at preventing hospitalization and lower respiratory tract disease in infants of moms who had received the RSV vaccine during pregnancy with a vaccine efficacy of around 82% at preventing these children from being hospitalized from lower tract infection during the first three months of life, and even beyond that between three and six months. of life, we know that the vaccine efficacy in preventing RSV lower tract infection and hospitalization in these young infants is around 70%. So very, very good vaccine efficacy, and is one way of protecting normal healthy infants against being hospitalized and having severe RSV disease.

The most important thing that pediatric providers can do is to vaccinate their patients against those viruses for which we have vaccines, mainly influenza, and COVID-19. With all these different viruses circulating at the same time, it is going to be critical that, you know, you provide vaccines to your patients in order to provide them with some protection, because what we're seeing in the hospital now is infants and children who are not only infected with one of these viruses, but with multiple of these viruses. And this really makes their clinical course much more complicated.

So I think the direction that IDSA wants to move in is really to address some of the disparities that were brought forth by the pandemic. And this is disparities in all age groups, but especially in the pediatric age group, and in the pregnant women group. Because most trials of drugs and vaccines that are done, generally are done in adults to begin with. And there is now a push to see whether or not some of these trials can also be started in infants and children and pregnant women in an earlier time, so that these therapeutics are available for these individuals much sooner than they normally would be available for so the Infectious Disease Society of America has always served as a resource, not only for the infectious disease physicians, but also for public health and for all other practitioners. If you go on to the Infectious Disease Society of America website, there are resources there that the general practitioner can use in their practices to provide the best care possible for their patients.

So I think what's really going to be exciting are some of the vaccines that are teed up to hopefully be approved by the beginning of 2023. I mean, one is the maternal RSV vaccine, and other one is PCV 20 or Prevnar 20, which is an increased valency pneumococcal conjugate vaccine that will provide more protection against the strains that are currently causing invasive pneumococcal disease now, as well as otitis media and pneumonia. And the other exciting vaccine that is teed up and may be licensed by sometime in mid 2023 Is the pentavalent Meningococcal vaccine. So this is a vaccine that covers meningococcal serotypes A, B, C, y and w. And I think this will greatly simplify the way that meningococcal vaccines are given and will provide the needed protection for those teenagers and young adults that are at risk for the disease.

Videos

Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of Contemporary Pediatrics, talks about the most significant moments in children’s health in 2022; what the tridemic really means for pediatric health care providers; and what we have to look forward to in 2023 when it comes to new vaccines and medications.

Tina Tan, MD, discusses most important pediatric news of 2022 and what to look forward to in 2023

Alok Patel, MD, is a pediatric hospitalist and clinical assistant professor of Pediatrics at Stanford Medicine Children's Health in Palo Alto, California. Here he discusses a potentially serious new strain of group A streptococcus, its presentations, and what health care providers should do right now to manage this illness.

Dr. Patel, thank you so much for joining us today. Let's just get right into it. There's a new, apparently serious invasive strain of strep A that was first noticed by the CDC in Colorado last month. Since then more states are reporting it and it looks like it's getting pretty scary. What can you tell us about this new strain?



Simply put, group A strep is a very common bacteria: we see millions of infections related to group A strep every single year, parents have heard of things like strep throat, skin infections. This is all group A strep. What is concerning, what is dangerous, potentially life threatening is when the bacteria moves from a place it normally is like your throat into a place it shouldn't be, like the blood deep muscles and your lungs. This is the transition from group A strep to invasive group A strep. And for parents out there who are seeing these headlines and freaking out, I totally get it. I'm also a parent. And what people want to be on the lookout for are infections or sicknesses that look particularly bad and worse than a common cold. Because invasive group A strep, when this bacteria is in a child's bloodstream, when it's causing something like necrotizing fasciitis, fancy term for flesh eating bacteria, when it actually causes rheumatic fever, scarlet fever, kids are going to look really sick. I'm talking really high fevers, muscle aches that are keeping kids up at night, warm, tender rashes on their body tender joints. These symptoms, this constellation should warn a parent to go and call a doctor immediately and not delay. We are also telling parents right now there is absolutely treatment for invasive group A strep in the form of antibiotics. But the most important thing is to not have a delay in care.



That makes total sense. Is there any relationship to this and what we've been hearing so much in the press about the triple endemic RSV and COVID and influenza. How does this connect with what's been talked about in those illnesses?



Several infectious disease experts in public health theorize that the rise of invasive group A strep right now is possibly related to what we're seeing with respiratory viruses. Because when anyone has a severe infection from a respiratory virus, whether it is RSV, COVID-19, or influenza, this makes the host, us, more susceptible to bacterial infections. This is why when parents look at the bottle of Tylenol or ibuprofen, it says contact a doctor after a certain amount of days of fever. This is because we worry about viral infections like influenza, RSV, or all the other cold viruses transitioning to bacterial. So this is one thought right now is it the fact that so many people out there are getting sick. This is why we're seeing a rise in invasive group A strep, but it's too early to kind of pinpoint what exactly is causing it.



So on top of all this, there have been reported shortages of over the counter medicines. Is this something that both parents and pediatricians need to worry about? Will this be addressed soon, do you think?



I think the concomitant shortage of basic antibiotics medications like amoxicillin, especially the oral suspension of amoxicillin that we give to young patients with these headlines about invasive group A strep is concerning because any pediatrician out there knows that amoxicillin is a frontline antibiotic to treat infections that are commonly caused by group A strep. It's really important that we have these. To open conversations with families, we help them find the medications, wherever they live, whatever pharmacy they're using, because what we don't want to see is a delay in care, because a family is scrambling to find a med, or because all of a sudden it's 6 pm, and the pharmacy next to them is closed. So what myself and a lot of my colleagues have been doing in the hospital setting is just making sure that that script is filled, and the family can access it before they get back to wherever they're going before they're traveling, wherever it may be, because we want to prevent those delays in care: even a delay in something like strep throat could be potentially serious if it transitions over and becomes invasive group A strep, and we can prevent it all with antibiotics. Right? It's also important that we educate our families about the difference between bacterial infections and viral infections. We've all had those patients who are a little bit resistant towards antibiotics and say, can I just get better on my own, and we're able to have that conversation, if we suspect it's a viral etiology for an illness. But if it's bacterial, it's super important to tell our families, this antibiotic is absolutely necessary. You have to take it, you have to take it for the full duration and not delay.



Right. So finally, what are the key takeaways would you say for pediatric health care providers who thinks they might be seeing this in their patients? What are the top things you suggest they do?



No physician out there is going to be surprised at a group A strep infection, but I think it's important for all of us just to revisit some of the signs and symptoms of invasive group A strep. I work as a hospitalist. I see kids with infections literally on a regular basis. And I myself just revisited some of the literature about scarlet fever, post strep glomerulonephritis, toxic shock syndrome, necrotizing fasciitis, just to make sure it's on my radar. And it's important that we give parents, we give patients, everyone out there, good preventive information about signs and symptoms to look out for: what to do if their children all of a sudden have a tender joint, or a really high fever or just appear slightly more sick than a routine cold. And we educate families about not delaying seeking medical care. We're kind of in this duality right now about telling people to avoid the ER or urgent care unless it's an emergency because hospitals are overrun, but then also telling parents, hey, don't delay. So I think we can find that happy medium right there and just tell parents, if there's any doubt, just call a doctor or clinic jump on a telehealth visit, because that small intervention could mean the difference between inpatient care for a child who has invasive group A strep and an outpatient antibiotic and everyone can have a happy holiday and be healthy.




Alok Patel, MD, shares what pediatric health care providers should know about a concerning new strain of group A streptococcus.

Alok Patel, MD, discusses the new invasive strep A strain

In this exclusive video interview, Steven Selbst, MD, pediatric emergency medicine physician at Nemours Children's Health, outlined how there has been an unprecedented number of pediatric respiratory syncytial virus (RSV) cases this season, and how hospitals have managed the overflow of patients.

"I've been around for many seasons of RSV, but this is probably the worst that we've had in terms of the number of cases and severity of the cases," Selbst said. According to Selbst, doctors are seeing a surge in RSV nationwide.

There is no definitive reason behind the surge of RSV, but 1 theory Selbst discussed was that children socially distancing and wearing masks during the COVID-19 pandemic caused their immune systems to no longer be primed. This led to older kids being infected with RSV and bringing the virus home, spreading it to younger kids.

The RSV season also began earlier, starting in the fall when it often begins in the winter. Selbst said this could also be related to precautions taken during the pandemic.

The surge in RSV has led to an increase in discussions about an RSV vaccine. While an RSV vaccine isn't expected to be ready this season, it is likely that there will be RSV vaccines available next season to protect children. Selbst has heard of many vaccines in development, including 1 which has been approved in Europe.

As RSV appears yearly, Selbst was confident that pediatricians know how to manage the virus. However, he encouraged pediatricians not to send patients to the emergency department (ED) in mild cases. EDs are overwhelmed nationwide, and there is no special treatment they can provide to babies and young kids present with RSV.

Selbst recommended treating RSV in babies with nasal suctioning and monitoring. This can be accomplished at home, rather than in the ED. Antibiotics are also unnecessary for treatment.

In severe cases, such as labored breathing, increased respiratory rate, retractions, head bobbing, and grunting, babies should be sent to the ED. Dehydration and poor feeding can also send a baby to the ED. Lastly, young infants aged under 2 months should be hospitalized, as they often end up in the intensive care unit.

Influenza cases have also risen, and COVID-19 continues to spread. Selbst recommended preparing for rough fall and winter seasons. 

Steven Selbst, MD, pediatric emergency medicine physician at Nemours Children's Health, discusses the surge of RSV cases and hospitalizations this season.

A look at RSV this season

Contemporary Pediatrics® Editor-in-Chief Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, sits down to discuss the recent surge in pediatric RSV hospitalizations and the rising threat of the "triple epidemic" consisting of influenza, COVID-1, and RSV in children. 

Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, sits down to discuss the rising threat of a  "triple epidemic" consisting of influenza, COVID-19, and RSV in children.

RSV, influenza, and COVID-19: Gearing up for the threat of a 'triple epidemic'

Gregg Sylvester, MD, MPH, chief health officer at CSL Seqirus, discusses an FDA-approved cell-based flu vaccine for children as young as 6 months, trends in childhood vaccination rates, and how to prepare for the upcoming flu season.

How to prepare for this upcoming flu season

In this video interview, Ian McGovern, epidemiologist, senior manager at CSL Seqirus, discussed the results of a recent study: "A Retrospective Database Analysis to Estimate the Epidemiology and Burden of Influenza in Children 0-14 Years Over 10 Consecutive Seasons."

McGovern noted how hospitals' resources are strained during the influenza season, even prior to the COVID-19 pandemic. Over 700,000 hospitalizations occur in the United States because of influenza annually, infection control measures draining hospital resources to prevent further spread.

COVID-19 has magnified the stress, according to McGovern, with fears of a "twindemic" occuring this season. This would be a case where influenza and COVID-19 both spread in the population, the number of infections pushing hospitals past their limits. Without proper resources in hospitals, mortality rates may rise.

For the past 2 years, COVID-19 precautions have led to drastically reduced cases of influenza. McGovern noted this reduces the possibility of people having a natural immunization, making them more susceptible to the flu. Young children are especially at risk, based on the study's results. 

Currently, influenza vaccines are the primary mode of prevention against severe cases of influenza, making them crucial among children. However, certain populations experience barriers to receiving vaccines. McGovern stated that these issues should be recognized and addressed so that more children may be vaccinated.

As a final note, McGovern recommended that parents speak with their child's health care provider and schedule an appointment to get vaccinated.

Ian McGovern, Epidemiologist, Senior Manager at CSL Seqirus, discusses new data on influenza gathered in a recent study, and how influenza rates are expecting to rise in the 2022 to 2023 flu season.

Influenza

News

What to expect this influenza season

*Editor's Note: Please note at the time of the interview there were 5 reported pediatric monkeypox cases. That number has since risen.

Craig Shapiro, MD, pediatric infectious disease specialist at Nemours Children's Hospital, sits down to discuss the recent uptick in pediatric monkeypox cases and explains what to do if you suspect your patient to have monkeypox.

Navigating monkeypox in children

Tina Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief, 

®; attending, division of infectious disease; medical director, international patient and destination services program at Ann & Robert H. Lurie Children’s Hospital of Chicago; and professor of pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, discussed the recent US Food and Drug Administration (FDA) approval of the PRIORIX (GSK plc) vaccine for measles, mumps, and rubella prevention. In a video, Tan highlighted the likely increase of vaccine availability due to the approval, which adds another manufacturer to the market and decreases the likelihood of shortages. Additionally, she noted that the PRIORIX vaccine can be used as a second dose to another, previously used MMR vaccine.

In a video for Contemporary Pediatrics®, Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses an expansion of vaccine access likely to come with the FDA approval of the PRIORIX vaccine. 

Vaccination and Immunization

Vaccines

PRIORIX FDA approval expands supply of MMR vaccines

The long and winding road to new innovations in medicine, from vaccines to  complex organ transplants, are not paved in gold. Quite the opposite. In his latest book, Paul A. Offit, MD, director of the Vaccine Education Center and professor of Pediatrics in the Division of Infectious Diseases at Children's Hospital of Philadelphia, discusses the sobering reality behind medical discovery.

Paul A. Offit, MD, pulls back the curtain on medical discoveries in "You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation"

Paul A. Offit, MD, discusses his latest book on the stories behind medical innovation

The US Centers for Disease Control and Prevention have been following the severe hepatitis outbreaks in children that have, to date, been detected in 36 states. 

' editor-in-chief, Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses what pediatricians should know about these cases, the chances of an outbreak in their own patient population, and what they should be discussing with caregivers.

Tina Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of Contemporary Pediatrics, shares her insights on the recent outbreaks of hepatitis in children.