Last week, Contemporary Pediatrics covered topics including the significance of setmelanotide’s FDA approval and the removal of age restrictions for epinephrine nasal spray. Take a look at some of our top stories from the past week (March 23-27, 2026) and click on each link to read and watch anything you may have missed.

Ashley Shoemaker, MD, MSCI, discusses leveraging setmelanotide in acquired hypothalamic obesity

In a recent video discussion with Contemporary Pediatrics, Ashley Shoemaker, MD, MSCI, an associate professor of pediatrics and pediatric endocrinology at Vanderbilt Health, shared critical insights into the evolving landscape of diagnosing and managing rare genetic obesity disorders.

The conversation centered on the recent FDA approval of setmelanotide (Imcivree; Rhythm Pharmaceuticals), which represents a significant milestone as the first targeted therapy for acquired hypothalamic obesity in patients 4 years and older. This condition, often resulting from rare genetic mutations or injury to the hypothalamus, has historically been difficult to treat, leaving clinicians and families with few effective options beyond standard lifestyle interventions that rarely address the underlying biological drivers of the disease.

With the introduction of setmelanotide, the pediatrician’s role has expanded to include critical longitudinal monitoring for patients on this new therapy. Although subspecialists such as pediatric endocrinologists typically handle the initial prescription and titration of setmelanotide, the pediatrician serves as the essential frontline observer. Shoemaker highlighted that pediatricians should be vigilant in monitoring for changes in linear growth and potential adverse effects.

Balancing universal and targeted screening for type 1 diabetes

In this interview with Contemporary Pediatrics, Shara Bialo, MD, a senior medical director at Sanofi, discusses the critical evolution of type 1 diabetes (T1D) screening, emphasizing a shift from reacting to symptoms to identifying disease biology in its early, presymptomatic stages.

Bialo characterizes the debate between targeted and universal screening as a “both/and” conversation. Although targeted screening for children with first-degree relatives is a logical starting point, it is insufficient as a stand-alone strategy. Approximately 90% of children who develop T1D have no family history of the disease, meaning a purely targeted approach misses the vast majority of future cases. Targeted screening should be considered the “floor, not the ceiling,” with pediatricians moving toward broader screening as access improves.

Stephanie DeLuca, PhD, discusses choosing the right approach for UCP

In a clinical discussion regarding infants with unilateral cerebral palsy (UCP), Stephanie DeLuca, PhD, an associate professor at the Fralin Biomedical Research Institute Neuromotor Research Clinic, emphasizes that choosing between high-dose interventions such as constraint-induced movement therapy (CIMT) and bimanual therapy depends significantly on family goals and the child’s developmental stage.

For infants who do not yet recognize their paretic side, CIMT may be preferred to encourage focus on that limb. Conversely, if a child is already incorporating the paretic hand into daily activities but lacks coordination, bilateral intensive therapy is often just as effective.

Addressing the logistical burden of a regimen requiring 3 hours per day, 5 days a week for 4 weeks, DeLuca notes that, although intensive, the therapy’s success-oriented nature provides rapid, visible changes. This immediate progress serves as a primary support mechanism for parents, offering a sense of accomplishment that is often missing from traditional distributed practice models. Practical support from extended family and pediatricians who acknowledge these positive changes further aids adherence.

Jennifer Hoffmann, MD, MS, discusses overtriage and disparities in pediatric behavioral health

In a recent interview with Contemporary Pediatrics, Jennifer Hoffmann, MD, MS, a pediatric emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, detailed the complexities of pediatric behavioral health triage within emergency departments, specifically focusing on the phenomena of overtriage and undertriage.

Overtriage occurs when a patient is assigned a higher priority level than their clinical needs actually require based on the resources used during their visit. Hoffmann noted that in her study, more than half of children presenting with behavioral health symptoms were overtriaged.

This is particularly prevalent among children aged 5 to 9 years, often involving those with autism spectrum disorder. Because these children may have limited communication abilities and express their needs physically or through aggressive behaviors, triage staff may assign higher acuity scores to ensure that they are seen quickly. However, these patients frequently do not require substantial emergency resources, leading to operational flows that divert care from others.

FDA removes age restriction for epinephrine nasal spray

The FDA has approved an update to 1-mg epinephrine nasal spray (neffy; ARS Pharmaceuticals) to remove the age criteria, allowing all patients weighing at least 33 lb to access the therapy regardless of age, according to ARS Pharmaceuticals.

Epinephrine nasal spray is an emergency treatment of type 1 allergic reactions, including anaphylaxis. Alongside the weight requirement, an age requirement of at least 4 years was previously necessary to use this treatment. However, the update has removed this requirement, alongside recommending that patients carry epinephrine nasal spray in the blister packaging or the designated carrying case.

“Severe allergic reactions are a major concern in early childhood, and parents often delay treatment because they are afraid of hurting their child with a needle injector or accidentally injecting themselves,” said Nicole Chase, MD, a board-certified allergy/immunology and pediatrics specialist at St Paul Allergy and Asthma.

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