Pediatr Ann
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The management of childhood spasticity requires a multidisciplinary effort. With input from pediatricians, physical and occupational therapists, neurologists, orthotists, orthopedic surgeons, neurological surgeons, and other healthcare personnel, effective treatment for spasticity can be initiated and maintained that can lead to meaningful improvements in quality of life for vast numbers of children. Neurosurgical treatment of spasticity will continue to evolve and be refined as procedures and techniques are appropriately evaluated with reliable and validated outcome measures.
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Childhood obesity is one of the formidable challenges that healthcare providers face. Early recognition and implementation of preventive strategies is crucial in combating this problem. Inculcation of a healthy lifestyle in our youth by encouraging physical activity, decreasing sedentary pastimes, and making healthy food choices is critical right from the start, before poor habits become ingrained. More research is needed to find more effective ways to treat obesity in childhood and adolescence.
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Many safe and effective treatments are available to the acne sufferer. The clinician is encouraged to offer treatment to the adolescent with a face full of pimples, even if not asked for by the patient, as psychosocial underpinnings may be present but not obvious on examination. Obvious physical benefits will result, but psychosocial improvements also may occur.
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Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. ⋯ Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.