Pediatric SuperSite Education Lab CME

Type 2 diabetes and dyslipidemias have, until recently, been the traditional realm of the internist and family practitioner, not the pediatrician. Type 1 diabetes, on the contrary, was thought to be a disease of “juvenile onset,” and, by adulthood, a cause of long-term poor outcomes.

Today, as the obesity epidemic moves apace, more children are developing type 2 diabetes and dyslipidemias, although regular exercise and careful management of diet and glycemic control dramatically reduce the risk for long-term sequelae from these diseases. Add to these basic measures the advent of improved pharmacological therapy, and many previously assumed outcomes will not manifest for many affected children.

Medical students rotating in a busy primary care pediatric clinic are often surprised by the volume of dermatology cases treated in this setting. Similarly, many young pediatricians just entering practice find themselves at a disadvantage when confronted by myriad skin conditions that do not necessarily present to the dermatologist first.

Yet, as the center of each their patients’ medical home, the general pediatrician should be skilled in recognizing and addressing common skin conditions, as well as in determining which cases would benefit further from subspecialty evaluation.

This issue of Pediatric Annals provides a focused review of pediatric inflammatory skin conditions, their typical presentations, and the pivotal role the primary care provider plays in the overall care team.

RSV: A Frontline Pediatrician’s Guide to Effective Prevention and Treatment” explored the disease burden of RSV, as well as strategies to implement and increase prophylaxis, while summarizing the latest data on treatment and management of complications.

Since the advent of effective vaccines, infectious diseases are no longer the primary concern of general pediatricians. Instead, they are faced with treating an increasing number of other illnesses, such as those related to behavioral health or metabolic syndrome.

For this reason, Pediatric Annals continues with this issue, a series of thoughtful challenges for community-based practitioners, who desire continuing medical education that embraces new paradigms in treatment.

Asthma is the most common chronic illness in children. Pediatricians must therefore be knowledgeable of how to diagnose and treat this condition. This monograph will review risk factors for asthma. Criteria for the risk assessment and diagnosis of this disease will be discussed. Guidelines for management of asthma according to disease severity level will be presented, and the efficacy and safety of available treatments will be evaluated.

With a shortage of pediatric mental health specialists, care for affected children increasingly falls to the primary care provider. Although more information and evidence-based care is available to help deliver low- to mid-level mental health care in the office setting, limitations such as time constraints and poor reimbursement remain.

This issue of Pediatric Annals is the second in a two-part series focused on the most common mental health issues in children; our October 2011 issue focused on diagnosis; this issue focuses on treatment. Both issues are intended to prepare pediatric primary care providers to treat children with mental health concerns, and to work as a more effective member of an interdisciplinary team.

Bacterial conjunctivitis is a condition commonly encountered in pediatric practices. Physicians must therefore be aware of how to diagnose and treat this infection. This monograph will review how to distinguish bacterial conjunctivitis from other types of conjunctivitis. Treatment options will be evaluated and discussed, along with clinical data on their efficacy, safety, and resistance patterns.

Pediatric primary care providers, faced with an ever-increasing number of children affected by mental health issues, are not always fully prepared to provide them with appropriate care.

As a result, residency programs have begun to offer mental health training to pediatric house staff, and a growing number of post-residency training programs are available to pediatric primary care physicians. This will help address both the lack of knowledge about mental health in the general pediatric primary care population, but much remains to be done.

This issue of Pediatric Annals is the first of a two-part series designed to help narrow this gap between knowledge and practice when diagnosing pediatric and adolescent mental health concerns.

In the past century, medicine has evolved from essentially a cottage industry of “one doctor, one patient” to a team endeavor with multiple professionals caring for a population of patients. These changes mean it is incumbent upon physicians to keep abreast of the latest advances in technology, communication skills, and processes of care delivery. As American industry has modernized, and patients rapidly integrate new technologies into everyday life, the health care system now looks to them for cues.

This issue of Pediatric Annals provides excellent reviews of key areas that require attention from all practicing child health care providers to meet the evolving needs and expectations of patients.

Nutritional issues are addressed at almost every visit to a pediatrician or child health specialist, whether for health maintenance or acute care. Adding to the challenge of assessing the nutritional status of any child is getting an accurate impression of their developmental status, environment, and social support structure. Medication management, ongoing chronic medical conditions, and the demands of a growing body all play a role as well.

This issue of Pediatric Annals provides several interesting and unique cases in childhood nutrition that illustrate challenges faced in the clinical setting on a daily basis. After reviewing these articles, the reader will be better prepared to serve as a guide and problem-solver for families with vexing nutritional issues.