Pediatric Annals (Pediatr Ann )


Pediatric Annals is America's most widely read journal for continuing education in the field of pediatrics. Each monthly issue provides a thorough, practical review of a single topic in pediatrics, carefully chosen by an editorial board composed of the leading pediatricians in the United States. Three credit hours in Category 1 for the Physician's Recognition Award of the AMA are offered for the successful completion of a CME quiz.

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Ataxia refers to motor incoordination that is usually most prominent during movement or when a child is attempting to maintain a sitting posture. The first part of the review focuses on the anatomic localization of ataxia - both within the nervous system and without - using a combination of historical features and physical findings. The remainder of the review discusses etiological considerations that vary depending on the age group under consideration. In infancy, certain specific diseases, such as opsoclonus myoclonus ataxia syndrome, must receive special mention because the underlying disease process may be amenable to surgical intervention. In the toddler- and school-age groups, certain conditions (such as stroke and acute cerebellitis) require immediate recognition and imaging, whereas others (such as post-infectious ataxia and concussion) require close follow-up. Finally, mention must be made of diseases outside of the central nervous system that can present with ataxia, such as Guillain-Barré syndrome.
    Pediatric Annals 04/2014; 43(4):153-9.
  • Pediatric Annals 04/2014; 43(4):123-4.
  • Pediatric Annals 04/2014; 43(4):139-40.
  • Pediatric Annals 04/2014; 43(4):141-2.
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    ABSTRACT: Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and self-limiting, excessive crying is associated with parental exhaustion and stress. However, an underlying organic cause is found in less than 5% of these infants. In the majority of cases, treatment consists not of "curing the colic," although usually it is possible to reduce crying, but of helping the parents to get through this challenging period in their baby's development. The aims of this review are to discuss definition, etiology, and evaluate different treatment regimes in infants who cry excessively.
    Pediatric Annals 04/2014; 43(4):e69-75.
  • Pediatric Annals 04/2014; 43(4):136-8.
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    ABSTRACT: Chronic nausea is a prevalent but poorly described symptom in adolescents. It often co-occurs with other functional gastrointestinal disorders (FGIDs) but may also present in isolation. A multitude of triggers and complex neural pathways underlie the sensation of nausea. These include gastrointestinal and blood-borne insults, dysmotility, vestibular or central nervous system pathways, an aberrant autonomic nervous system, and psychosocial factors. Although clinical algorithms are lacking, diagnosis is typically made on the basis of a thorough clinical history and without extensive testing. Treatment is mainly empiric and may be directed at comorbid symptoms such as migraine, delayed gastric emptying, orthostatic intolerance, and visceral hypersensitivity. Chronic idiopathic nausea is an increasingly prevalent symptom that needs careful clinical assessment and individualized treatment plans.
    Pediatric Annals 04/2014; 43(4):e89-94.
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    ABSTRACT: Biliary dyskinesia (BD) is a diagnosis that is being made increasingly in children. It is defined by abdominal pain thought to be biliary in nature based on location and character; a completely normal gallbladder on imaging tests, typically ultrasound; and decreased gallbladder contraction in response to a pharmacological stimulus. Unlike other functional gastrointestinal disorders (FGIDs) that are treated with medications, behavioral therapy, and/or dietary modification, current clinical practice has accepted cholecystectomy as the treatment of choice for BD, which now accounts for up to 50% of cholecystectomies in children. Although well-designed trials are missing, accumulating evidence argues against such an approach. First, BD is by definition a benign disorder without risk of truly relevant complications. Second, despite reportedly high rates of satisfaction with postoperative outcomes, most children continue to experience symptoms. Lastly, limited long-term studies have demonstrated comparable benefit of operative and conservative therapy. To summarize, BD should be seen as a more localized manifestation of functional abdominal pain, which may improve over time independent of the type of therapy chosen. Despite the widespread adoption of minimally invasive surgery in pediatrics, a different risk-benefit ratio favors conservative treatment for this benign disorder.
    Pediatric Annals 04/2014; 43(4):e83-8.
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    ABSTRACT: Functional dyspepsia (FD) is a widely prevalent problem in pediatrics, reportedly occurring in 3% to 27% of children and accounting for considerable impact on quality of life and health care costs. FD is defined by the Rome III classification as persistent upper abdominal pain or discomfort, not related to bowel movements, and without an organic cause, that is present for at least 2 months prior to diagnosis. Abnormal sensory perception, motor dysfunction, and psychosocial factors have been implicated in the causation of FD. Hypersensitivity to gastric distension, delayed gastric emptying, antral hypomotility, and gastric dysrhythmia are some abnormalities that have been noted in FD. Diagnosis of FD is based on a thorough history and examination, and an appropriate selection of tests based on clinical judgment, the presence of alarm signs, and response to treatment. A positive diagnosis of FD helps to shift focus from further testing to treatment of symptoms. The majority of children with dyspepsia do not have mucosal lesions on endoscopy; hence, endoscopy is not mandatory for the diagnosis of FD. Helicobacter pylori is an uncommon cause of dyspepsia in children, and test and treat strategy is discouraged. Delayed gastric emptying may be present in up to 70% of children with dyspepsia. A biopsychosocial approach to treatment involving medications, psychological and social supports, and complementary therapies is advocated. Proton pump inhibitors (PPIs) and prokinetics are commonly used first-line medications. PPIs are preferred when epigastric pain is the predominant symptom, whereas prokinetics may be chosen when postprandial fullness or early satiety is the main symptom. PPIs may be more efficacious and cost-effective than H2 blockers according to adult data.
    Pediatric Annals 04/2014; 43(4):e101-5.
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    ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder in children and adults. The pathogenesis and pathophysiology of IBS remains incompletely understood. The biopsychosocial model, which conceptualizes chronic pain as a dysregulation of the gut-brain-homeostasis with peripheral and central factors mutually influencing each other, is the most accepted framework to explain IBS. Twin and family aggregation studies suggest a genetic component that does not exclusively explain the higher prevalence of IBS in certain families. Social learning (environmental factors) and maladaptive coping predispose children to develop IBS with greater disability and more frequent medical consultations. Early-life events constitute an additional risk factor for the development of IBS and other functional gastrointestinal disorders (FGIDs). Children with a history of cow's milk protein hypersensitivity or abdominal surgeries have a higher prevalence of IBS and other FGIDs years later. IBS frequently follows an episode of acute gastrointestinal inflammation (infectious or non-infectious). This article discusses the importance, known pathophysiological mechanisms, clinical approach, and evidence-based therapeutic options for the management of IBS in children and adolescents.
    Pediatric Annals 04/2014; 43(4):e76-82.
  • Pediatric Annals 04/2014; 43(4):129-34.
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    ABSTRACT: Adolescent Rumination Syndrome (ARS) is a relatively uncommon disorder, defined by the involuntary regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or re-swallowed. Although the disorder itself is not life-threatening, it typically has a significant medical and psychosocial impact on the patient and family. There continues to be limited awareness about the clinical presentation, diagnosis, and treatment of ARS among clinicians. As such, adolescents presenting with symptoms of ARS often are misdiagnosed and typically undergo avoidable, extensive, invasive, and costly testing. This article seeks to increase awareness and knowledge about ARS, and to provide the clinician with practical guidelines regarding the pathogenesis, assessment, diagnosis, and treatment of ARS.
    Pediatric Annals 04/2014; 43(4):e95-e100.
  • Pediatric Annals 04/2014; 43(4):125-8.
  • Pediatric Annals 03/2014; 43(3):87-88.
  • Pediatric Annals 03/2014; 43(3):95-100.
  • Pediatric Annals 03/2014; 43(3):107.
  • Pediatric Annals 03/2014; 43(3):115-120.
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    ABSTRACT: A 14-year-old female presented to our hospital for a second opinion regarding a recent diagnosis of Graves' disease and a mediastinal mass. Four months prior to presentation, the patient developed difficulty with concentration. Historically she had been an A/B student; however, her school performance worsened suddenly, and she almost failed the eighth grade. One month later, she began complaining of increased sweating, diarrhea, difficulty with balance, jitteriness, and difficulty sitting still. During the previous 2 months, she had an increased appetite along with a 10-lb weight gain, increased hair loss, fatigue, and dry skin. Two weeks prior to her presentation, her mother noted that she had a "large neck mass." At that time, the patient complained of dysphagia and tenderness of the anterior neck on palpation, but she had no respiratory difficulties. In addition, she had no symptoms of fever or night sweats.
    Pediatric Annals 03/2014; 43(3):e65-e68.
  • Pediatric Annals 03/2014; 43(3):91-94.

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