There’s much to read between the covers, so get started!

Fever without source in the well-seeming infant

Otherwise well-appearing infants presenting with fever without a source (FWS) can confound the clinician who may suspect a urinary tract infection (UTI), but may lack clear diagnostic evidence to warrant initiation of antibiotic therapy. UTIs are the most common serious bacterial infection (SBI) in infants and young children, but their diagnosis is challenging in this population.

In this issue, Dr. Bass’s article, “Fever without a source, think UTI first,” invites pediatricians to consider the patients’ risk profile, genitourinary system diagnoses, and the AAP’s recently reaffirmed guidelines on UTI treatment in their approach to these young patients.

Are they in pain? Crying in the neurologically impaired child

In our peer-reviewed clinical feature this month, “Persistent agitation in children with neurologic impairments,” David Hall, MD, Professor of Clinical Pediatrics, Vanderbilt University School of Medicine, Section Head, Program for Children with Medically Complex Needs, advises on the treatment of special needs children who exhibit persistent crying with seemingly no underlying causation.

According to Hall, getting to root causes with these patients requires patience and persistence-and sometimes educated trial and error. In this stepwise and practical presentation, Hall equips pediatricians on how best to engage parents and caregivers in the search for the best treatment.

“Persistent crying, agitation, or irritability in nonverbal children with severe neurological impairment is a frustrating and all too common problem for parents and their providers,” Hall explains. “These children appear to be in pain, but the cause is not apparent.”

“Our article describes a potentially satisfying approach to the management of these patients that is based on shared decision making with families combined with the methodical consideration of common causes.”

Our online exclusive video for July-ADHD meds and outcomes

Even with medication, one large study* showed that children treated for attention-deficit/hyperactivity disorder (ADHD) had worse school performance and worse health outcomes than their untreated peers. They were also at higher risk of low academic attainment and unemployment after leaving school, according to the authors of the study published in JAMA Pediatrics.

Researchers examined data on 766,244 children obtained from 8 administrative databases in Scotland, an investigation more than 4-fold the size of previous studies reporting similar educational outcomes.

In his video highlighting the study, Contemporary Pediatrics’ Robert R Lazzara, MD, observes, “ADHD diagnosis and treatment are still in question in many instances as reflected in this study. Diagnostic and treatment modalities in ADHD need to be individualized. Perhaps this study is an example of where precision medicine can be utilized in pediatrics and blanket pharmacologic approaches need to be questioned.”

*Fleming M, et al. Educational and health outcomes of children treated for attention-de­ ci/hyperactivity disorder. JAMA Pediatr. 2017;e170691.

Our latest Dispatches from readers in the field

We are pleased in this issue to present the latest installment of our recurring column Dispatches, which highlights the creativity of our pediatric readers who have encountered an issue in their practices and then brainstormed and pilot-tested a solution. Our contributors’ how-to’s are tailor made for you to consider adopting in your own practice. And, in the collaborative spirit of the Contemporary Pediatrics community, we always invite readers to contact our Dispatches contributors directly in order to further brainstorm how their ideas might be adopted, adapted, and retrofitted.

In this month’s Dispatches, one pediatric hospitalist’s 4 common-sense strategies for sending term infants home to stay virtually eliminated his hospital’s 30-day newborn readmissions.

Ronald Flaster, MD, talks about the concept, its impressive results, and how the linchpin to its implementation success was getting buy-in from the multidisciplinary team.