Pediatr Ann
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Extreme obesity is defined by the Centers for Disease Control and Prevention as a body mass index (BMI) higher than 120% of the 95th percentile for age. Four to six percent of American youths fall into this subcategory and are at increased risk for developing comorbidities, including hypertension, dyslipidemia, nonalcoholic fatty liver disease, insulin resistance, sleep apnea, and bone and joint problems. Many studies have shown that nonsurgical treatment programs do not provide significant long-term improvements in BMI in adolescents with severe obesity. ⋯ This review highlights the indications for bariatric surgery in adolescents and outlines practice guidelines for adolescent surgical weight loss programs. The authors summarize available data on the effects of adolescent weight loss surgery on metabolic comorbidities and highlight the important acute and long-term complications that must be monitored by their general pediatricians. After reading this article, the general pediatrician should be able to identify adolescents who may be candidates for weight loss surgery and have the knowledge to assist in their postoperative medical management.
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Asthma is one of the most common childhood diseases in the world and a significant cause of morbidity and health care expenditures. United States and international evidence-based guidelines created and updated in the past 2 decades have significantly improved the consistency and effectiveness of asthma care in children. Assessing severity and monitoring control using the impairment and risk domains is fundamental to effective management. ⋯ Inhaled corticosteroids remain the preferred controller in persistent childhood asthma; however, especially in young children, a discussion should occur with caregivers regarding possible adverse effects. Similarly, if long-acting beta-2-agonists are added to inhaled corticosteroids at step 3 care and above, the risk of severe asthma-related events should be discussed. Indications for referral to an asthma specialist include difficult-to-treat asthma, step 4 care and above, risk factors for severe asthma related events, subtypes of asthma, and doubts of asthma diagnosis.
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The field of pediatric pain management continues to evolve, with ongoing changes in our appreciation of the impact of pain on our fragile patients, a better understanding of how to assess pain, and refinements of the medications and techniques used to provide analgesia to patients with acute pain of various etiologies. The following article reviews the techniques for the assessment of pain, including various age-specific pain scoring systems. The pharmacological management of pain is discussed, including the use of agents that inhibit prostaglandin formation-nonsteroidal anti-inflammatory agents and acetaminophen-as well as the "weak opioids" that are commonly used when oral administration is feasible for the treatment of mild to moderate pain.
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Pediatric hospital medicine (PHM) is moving toward becoming an American Board of Pediatrics (ABP) subspecialty, roughly a decade after its formal inception in 2003. Education has played a central role as the field has evolved. Hospitalists are needed to educate trainees, medical students, residents, fellows, and nurse practitioner and physician assistant students in inpatient pediatric practice. ⋯ PHM educators are changing the educational paradigm to address challenges to traditional education strategies posed by duty hour restrictions and the increasing drive to shorten the duration of the hospitalization. By embracing learning with technology, such as simulation and e-learning with mobile devices, PHM educators can address these challenges as well as respond to learning preferences of millennial learners. The future for PHM education is bright.