PURPOSE OF REVIEW:Fifth metatarsal fractures are the most common metatarsal injury in the pediatric population; however, their management is frequently extrapolated from adult protocols. This review explores the emergence of pediatric-specific classification systems and evolving evidence on surgical versus conservative treatment in skeletally immature patients. RECENT FINDINGS:Anatomical and developmental differences critically distinguish pediatric fractures from adult fractures. Recent pediatric classifications, including those by Herrera-Soto and Lee, improve upon the widely used Dameron/Lawrence-Botte system by recognizing the apophysis as a distinct entity and offering better prognostic correlation. Zone 1 avulsion fractures achieve near-universal healing with conservative management. Emerging evidence supports surgical fixation with intramedullary screws for Zone 2 (Jones) fractures in adolescent athletes, whereas prepubertal patients respond well to conservative treatment. Nutritional factors, particularly vitamin D deficiency and inadequate calcium intake, are increasingly being recognized as modifiable risk factors for stress fractures and delayed union. SUMMARY:The management of fifth metatarsal fractures should be individualized according to the fracture zone, skeletal maturity, and activity level. Pediatric-specific classifications offer improved diagnostic accuracy. Nutritional optimization should be integrated into comprehensive management protocols, and further pediatric-focused clinical trials are needed.
PURPOSE OF REVIEW:This review examines prevalence, diagnosis, and management strategies for cardiovascular risk factors including dyslipidemia, hypertension, and obesity in children and adolescents. As these risk factors begin in childhood and track into adulthood, early intervention is important in preventing cardiovascular disease, the leading cause of mortality in the United States. RECENT FINDINGS:The American Heart Association's Life's Essential 8 characterizes components of cardiovascular health including health behaviors (diet, exercise, sleep, tobacco use) and health factors (blood lipids, blood pressure, blood glucose, and weight). Optimizing these health metrics is associated with favorable overall and cardiovascular health (CVH) outcomes. In the United States, prevalence of hypertension, obesity, and cardiovascular disease is projected to rise over the next decade, while hypercholesterolemia is declining. While lifestyle modifications remain a cornerstone in care, new pharmacotherapeutic options have emerged for children over the past several years to treat dyslipidemia and obesity. SUMMARY:Pediatric clinicians have an important role in counseling and supporting CVH in children. This review examines aspects of CVH that are commonly managed in preventive cardiology programs, focusing on diagnostic evaluation and treatment strategies, highlighting new and emerging therapies for children and adolescents, including pharmacotherapy and latest research on effective lifestyle modifications.
PURPOSE OF REVIEW:The coronavirus disease 2019 pandemic, shifting health policy and increasing vaccine hesitancy have all increased the likelihood healthcare practitioners will encounter vaccine-preventable diseases in children. Both front-line and consulting clinicians need to be able to identify these previously rare diseases and their neurologic complications, particularly in un- or under-vaccinated children. RECENT FINDINGS:As diseases previously considered rare or eliminated reemerge, more is known about direct and indirect consequences of peripheral and central nervous system infection in children-both in general and specific to individual vaccine-preventable diseases. Primary and secondary neurologic complications can be acute, subacute, chronic, or arise years later. Advances in imaging and molecular identification along with better understanding of underlying disease pathophysiology can all aid earlier identification, treatment, prognostication, and recovery. SUMMARY:While the benefits of childhood vaccination programs clearly outweigh the risks for the majority of children, in light of current realities the goal of this guide is to better prepare front-line and consulting clinicians to identify and manage vaccine-preventable diseases and their neurologic complications in un- or under-vaccinated children as they increasingly encounter them now and in the future.
Purpose of review Moyamoya is an important cause of stroke across the lifespan and accounts for up to 10% of pediatric ischemic strokes. Recent advances in genetic discovery, neuroimaging, surgical timing, and perioperative consensus have substantially changed the landscape of pediatric moyamoya care, necessitating a focused update for clinicians managing children with this disease. Recent findings Identification of RNF213 Arg4810Lys as the primary susceptibility variant and the role of a second-hit mechanism involving immune activation and hypoxia has advanced understanding of moyamoya pathogenesis and phenotypic heterogeneity. Multidelay ASL MRI has emerged as a valuable tool for perioperative perfusion assessment. A modified Delphi consensus established foundational perioperative care standards, while recent data highlight that surgical timing, postoperative hemodynamic management, and long-term neurocognitive and systemic outcomes remain critical gaps. Summary Surgical revascularization remains the mainstay of treatment and dramatically reduces stroke recurrence in children with moyamoya. Structured long-term surveillance encompassing neurocognitive assessment, mental health screening, and systemic comorbidity monitoring should be implemented as standard of care, as outcomes extend well beyond stroke prevention.
PURPOSE OF REVIEW:Artificial intelligence applied to electrocardiography (AI-ECG) has rapidly been investigated in adult cardiovascular medicine, yet translation into pediatric and congenital heart disease populations has lagged. This review summarizes contemporary AI-ECG methodologies and emerging applications in pediatric and congenital heart disease (PCHD), with emphasis on current clinical utility, technical challenges, and future opportunities for implementation. RECENT FINDINGS:Recent studies demonstrate that deep learning models can accurately identify arrhythmias, ventricular dysfunction, and CHD from standard ECG. Convolutional neural networks remain the dominant architecture, although transformer-based foundation models and self-supervised learning approaches are increasingly being explored. AI-ECG applications in PCHD have expanded from automated interpretation toward proactive risk stratification, including prediction of ventricular dysfunction, mortality, and sudden cardiac death risk. Additional work has investigated wearable monitoring, telemetry analysis, and integration with longitudinal clinical data. Despite promising performance, most studies remain retrospective and single-center, with limited external validation and challenges related to small datasets, physiologic heterogeneity, and age-dependent ECG variation. SUMMARY:AI-ECG has the potential to transform PCHD by improving diagnostic accuracy, enabling earlier disease detection, and enhancing longitudinal risk assessment. Broader clinical implementation will require multicenter collaboration, prospective validation, standardized datasets, and careful attention to ethical, regulatory, and equity considerations.
PURPOSE OF REVIEW:This review aims to summarize recent advances in the diagnosis, epidemiology, pathophysiology, and management of pediatric abdominal pain-related disorders of gut-brain interaction (AP-DGBI), including irritable bowel syndrome (IBS) and functional abdominal pain - not otherwise specified (FAP-NOS). Emphasis is placed on emerging diagnostic tools, updated international guidelines, and novel therapeutic approaches. RECENT FINDINGS:Novel diagnostic scoring systems may improve clinical evaluation. Growing evidence also supports the role of sleep, biopsychosocial model, and family dynamics in disease severity and persistence, suggesting additional targets in treatment. The recent 2025 ESPGHAN/NASPGHAN guidelines provide evidence-based recommendations for the management of AP-DGBI. Evidence for pharmacologic and nonpharmacologic therapies is promising, although data remains limited. SUMMARY:Pediatric AP-DGBI are common and significantly impair quality of life. Advances in diagnostic approaches, our understanding of prevalence and pathophysiology, and growing evidence for both pharmacologic and nonpharmacologic therapies for AP-DGBI may improve future management. Larger high-quality pediatric trials are needed. A multidisciplinary, patient-centered approach using the biopsychosocial model remains at the forefront of optimizing outcomes.
PURPOSE OF REVIEW:To synthesize current practice patterns, expert consensus, and evidence-informed recommendations for the evaluation and management of patients with anorectal malformations (ARMs). RECENT FINDINGS:Adoption of standardized, anatomy-based classification systems has improved consistency in reporting and enabled more robust multiinstitutional research. Increasing centralization of care within multidisciplinary colorectal centers has enhanced coordinated evaluation across multiple surgical subspecialties. Early, comprehensive screening for associated anomalies - particularly renal, spinal, and Müllerian abnormalities - remains critical, though gaps in detection persist. Initial management strategies emphasize ensuring effective bowel decompression through dilation, diversion, or selective primary repair. Surgical management continues to evolve, with growing evidence supporting selective single-stage repair in low malformations and utilization of emerging techniques aimed at minimizing morbidity while preserving function. Contemporary data highlights the importance of risk-stratified, longitudinal urologic surveillance given the high prevalence of renal and bladder dysfunction, particularly in patients with high fistula insertion or persistent cloaca, upper urinary tract anomalies and/or clinically significant spinal dysraphism. SUMMARY:Optimal neonatal management of ARM includes comprehensive screening for associated anomalies, early multidisciplinary involvement, and individualized decision-making regarding timing and approach to repair, ideally within experienced, high-volume centers.
PURPOSE OF REVIEW:To outline the current advances in food allergy. RECENT FINDINGS:Food allergies have been increasing in prevalence and significantly affect the quality of life of both patients and their families. Over the past decades, there have been major changes to the recommendations for prevention and management of food allergies. These include timely introduction, various forms of immunotherapy, biologics, and epinephrine administration. SUMMARY:As the effectiveness of many of these therapies are optimized in childhood, it is critical to be aware options are available. Shared decision-making is essential in navigating the current landscape of food allergy management.
PURPOSE OF REVIEW:Neurogenic bowel and bladder are common comorbidities found in children with spinal dysraphism. Although historically managed reactively, treatment focus has shifted toward proactive surgical and medical management aimed to preserve renal function and achieve social continence. This review evaluates recent evidence in the evaluation and surgical management of these conditions, emphasizing a multidisciplinary approach to ensure long-term independence for pediatric patients with spinal dysraphism. RECENT FINDINGS:Recent guidelines suggest delaying initial renal imaging until 48 h postbirth for accuracy. Newer evidence also indicates that ultrasound alone is insufficient for monitoring renal health, requiring supplemental markers like cystatin C. Bladder management continues to evolve with the success of awake outpatient botulinum toxin-A injections. Surgical options including robotic-assisted and single-incision laparoscopic techniques for continent bowel and bladder channels demonstrate high success rates, with multiinstitutional data specifically highlighting high family satisfaction with the Malone Antegrade Continence Enema (MACE). SUMMARY:Proactive management is essential for optimizing long-term outcomes for children with spinal dysraphism. While surgical advancements improve recovery and continence, high rates of nonadherence to catheterization and bowel management protocols remain a challenge. Successful management requires balancing innovative surgical techniques with patient preferences and longitudinal support to ensure lifelong health and independence.
PURPOSE OF REVIEW:Pediatric inflammatory bowel disease (PIBD) has a rising global prevalence, with patients often demonstrating more aggressive and extensive disease activity compared to adult-onset disease. With improved access to therapeutic agents outside of the anti-TNF-α class, we seek to provide an updated framework for the management of PIBD patients through use of advanced biologic and small molecule therapies and to give guidance on the use of dual targeted therapy (DTT). RECENT FINDINGS:Although anti-TNF agents remain first-line options for moderate-to-severe Crohn's disease and ulcerative colitis, emerging pediatric clinical trial and real-world data support the use of vedolizumab and ustekinumab as second-line therapies. While PIBD-specific data are limited, novel anti-IL-23p19 agents and oral Janus kinase inhibitors (JAKi) have shown promising results for refractory disease. Emerging evidence supports the use of DTT for PIBD patients who do not achieve remission endpoints with use of a single agent. SUMMARY:Early aggressive intervention with advanced therapies leads to improved clinical outcomes in PIBD patients with moderate-to-severe disease activity. Proactive therapeutic drug monitoring (TDM) and strategic use of DTT allow for improved durability of therapy and better clinical remission rates. Additional pediatric studies are needed to properly position novel anti-IL-23p19 and JAKi agents.
PURPOSE OF REVIEW:Sleep disorders significantly impact pediatric cognitive development and behavioral health. As pediatric obesity and neurodevelopmental diagnoses rise, primary care providers require updated frameworks to differentiate between anatomical, behavioral, and circadian-driven sleep disturbances to ensure timely intervention. RECENT FINDINGS:Pediatric obstructive sleep apnea (OSA) is primarily linked to adenotonsillar hypertrophy, with the CHAT study highlighting that surgical intervention significantly improves quality of life and behavior. Behavioral insomnia remains prevalent, effectively managed through extinction-based techniques. Furthermore, adolescents increasingly face Delayed Sleep-Wake Phase Disorder, where management has shifted toward environmental light manipulation and strategic melatonin dosing to realign internal biological clocks with school schedules. SUMMARY:Effective management requires integrating oropharyngeal exams and sleep hygiene counseling into routine well child visits. While adenotonsillectomy remains the gold standard for OSA, behavioral and circadian issues are best addressed through caregiver education and consistent routines. Early identification by pediatricians reduces long-term neurobehavioral morbidity and guides necessary specialist referrals.
PURPOSE OF REVIEW:Children with hereditary polyposis syndromes require long-term endoscopic surveillance to reduce risks of gastrointestinal complications: malignancy, bleeding, and obstruction, among others. However, surveillance remains challenging because of variable lesion distribution, subtle morphology, interobserver variability, and the burden of repeated procedures throughout the patient's lifetime. Artificial intelligence has transformed adult endoscopy, but its application in pediatric polyposis is less defined. This review summarizes current evidence and explores potential applications for children with hereditary polyposis syndromes. RECENT FINDINGS:In adult colonoscopy, meta-analyses and randomized trials demonstrate that artificial intelligence improves adenoma detection rates (ADR) and reduces missed lesions, though evidence linking these benefits to meaningful reductions in colorectal cancer incidence remains insufficient. In capsule endoscopy, artificial intelligence demonstrates high sensitivity for lesion detection while substantially reducing review time. Pediatric data remain limited, with no studies specific to hereditary polyposis syndromes, but early studies support feasibility. Potential applications include automated polyp detection, localization, burden quantification, and longitudinal comparisons across surveillance examinations. SUMMARY:Artificial intelligence has significant potential to improve polyp detection, diagnostic consistency, accuracy, efficiency, and longitudinal disease monitoring in pediatric hereditary polyposis syndromes. Development of pediatric-specific datasets and prospective, multicenter, and outcome-driven validation studies will be essential before widespread clinical implementation.
BACKGROUND:Acne vulgaris is one of the most common inflammatory skin conditions in adolescents, affecting up to 85% of individuals aged 12-24 years. Beyond its physical manifestations, acne can significantly impact self-esteem, quality of life, and psychological well-being. DISCUSSION:Acne has a multifactorial pathogenesis involving follicular hyperkeratinization, increased sebum production, Cutibacterium acnes colonization, and inflammation. Hormonal influences, particularly androgen-mediated sebaceous gland activity during adrenarche, play a central role in disease development. In some patients, hormonal factors may be more prominent, with clinical features including acne concentrated on the lower face and jawline and flares associated with the menstrual cycle. CONCLUSION:Recognition of acne as a chronic inflammatory condition has supported the increasing use of hormonal therapies as an important treatment option in selected adolescent patients.
PURPOSE OF REVIEW:Hidradenitis suppurativa is a chronic inflammatory skin disease causing recurrent abscesses, tunnels, and scarring. Despite significant disease burden in children and adolescents, treatment data for this population remains limited. This review summarizes the most recent developments in pediatric hidradenitis suppurativa management. RECENT FINDINGS:The 2025 North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special populations included key consensus-based treatment recommendations for pediatric hidradenitis suppurativa. Although antibiotics remain the mainstay of treatment for acute flares, adult data support the use of intravenous ertapenem as a rescue therapy for severe, recalcitrant hidradenitis suppurativa. Hormonal therapies, including spironolactone and combined oral contraceptives, should be considered in postmenarchal women. Metabolic therapies, particularly metformin and GLP-1 receptor agonists, are newer adjunctive options for patients with comorbid obesity and insulin resistance. Secukinumab was recently approved for moderate-to-severe hidradenitis suppurativa in adolescents at least 12 years, and clinical trials for multiple other biologic therapies for pediatric hidradenitis suppurativa are underway. SUMMARY:Patients with pediatric hidradenitis suppurativa require individualized management approaches that consider their unique comorbidities and stages of development. Clinicians should integrate the 2025 North American guidelines into clinical practice, recognize, and co-manage comorbidities when appropriate, and counsel patients on approved and emerging biologic options.
PURPOSE OF REVIEW:This review aims to summarize recent literature on artificial intelligence (AI) tools for adolescent mental health, including the types of tools available, their clinical applications, effectiveness, and safety, as well as relevant ethical considerations. RECENT FINDINGS:For clinicians, AI can facilitate clinical documentation, enhance therapy, and support the diagnosis process. Adolescents show interest in using AI for their mental healthcare and can benefit from AI-guided therapy apps and chatbots. Most studies that show effectiveness focus on depression treatment. Many tools are only in the prototyping stage, not tested on clinical samples, or lack safety measures, highlighting the need for further safety evaluation before specific app recommendations can be made. SUMMARY:AI is increasingly being implemented in pediatric health systems and adolescents' daily lives. Adolescent medicine practitioners should recognize the growing potential for certain AI applications to enhance access and support adolescents, review and utilize those applications that have empirical support of efficacy, and that provide guardrails for safe and ethical use.
PURPOSE OF REVIEW:Loss-of-function mutations in MKRN3 are the most common monogenic cause of central precocious puberty (CPP), yet the functional consequences of missense variants, which account for the majority of such cases, remain incompletely understood. A growing body of genetic, biochemical, computational, and in vivo studies now allows a domain-by-domain dissection of how missense mutations impair MKRN3 function, offering mechanistic insight into pubertal regulation that extends beyond individual variant reporting. RECENT FINDINGS:Missense mutations in the C3HC4 RING finger domain consistently reduce ubiquitin ligase activity and impair MKRN3-mediated repression of neurokinin B, kisspeptin, and GnRH, while mutations in C3H zinc finger domains paradoxically enhance auto-ubiquitination or disrupt RNA binding, revealing distinct pathogenic mechanisms. Computational stability analysis shows that destabilizing and stabilizing variants can both be pathogenic, underscoring the limitations of in silico tools alone. Phenotypic variability is shaped by the classes of mutations, sexually dimorphic neuroendocrine sensitivity, epigenetic regulation of MKRN3 promoter activity, and polygenic modifiers of pubertal timing. SUMMARY:Understanding the domain-specific effects of MKRN3 missense mutations refines genotype-phenotype correlations and improves variant interpretation in clinical practice. Integration of functional assays with polygenic risk assessment is essential for accurate genetic counseling in families with CPP.
PURPOSE OF REVIEW:To review the current literature for updates on pediatric nonsteroidal topical therapies (NSTT) for the treatment of atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo, and seborrheic dermatitis (SD). RECENT FINDINGS:The FDA approved difamilast and expanded the approved age ranges for roflumilast, tapinarof, and ruxolitinib to treat AD. Recent studies also show positive results with delgocitinib. In the field of psoriasis, current research shows promise for tapinarof and roflumilast in an expanded age range. Among new AA treatments, relevant literature supports the use of both ruxolitinib and tofacitinib. Research in pediatric vitiligo is currently focused on roflumilast and latanoprost. The FDA approved age ranges for roflumilast in SD treatment was expanded, and recent data shows promising efficacy and safety with long term use. SUMMARY:Current pediatric topical therapies are limited for the treatment of AD, psoriasis, AA, vitiligo, and SD. Historically, first line treatment options have included topical corticosteroids (TCS), though these have an increased risk of side effects in a pediatric population. Future clinical practices will likely rely less on TCS and more on NSTT for treatments of chronic pediatric dermatologic conditions.
PURPOSE OF REVIEW:To provide a comprehensive and updated overview of post-infectious bronchiolitis obliterans (PIBO) in children, focusing on pathogenesis, diagnostic approaches, and current management strategies, while highlighting emerging mechanistic insights and future therapeutic directions. RECENT FINDINGS:Recent studies emphasize neutrophilic inflammation, inflammasome activation (e.g., interleukin-18, caspase-1), and genetic susceptibility as key contributors to disease development and progression. SUMMARY:PIBO is a heterogeneous and often underrecognized chronic lung disease requiring a structured diagnostic approach based on clinical, functional, and radiologic criteria. Management remains largely empirical and supportive, with limited evidence for disease-modifying therapies. Improved understanding of disease mechanisms may enable the development of targeted, phenotype-directed interventions in the future.
PURPOSE OF REVIEW:Congenital adrenal hyperplasia (CAH), most commonly caused by 21-hydroxylase deficiency, remains associated with substantial morbidity despite life-saving glucocorticoid replacement. This review is timely because several novel therapies have recently emerged with the potential to improve disease control while reducing glucocorticoid burden. RECENT FINDINGS:Recent advances in CAH management include modified-release hydrocortisone, which better mimics physiological cortisol secretion and may improve androgen control with lower glucocorticoid exposure. Steroid-reducing agents have advanced rapidly, particularly the corticotropin-releasing factor type 1 receptor antagonist crinecerfont and the melanocortin 2 receptor (MC2R) antagonist atumelnant, both of which show promise in lowering adrenocorticotropic hormone (ACTH)-driven androgen excess and facilitating glucocorticoid dose reduction. Additional emerging approaches include insurmountable MC2R antagonists and the anti-ACTH monoclonal antibody Lu AG13909. Gene therapy and genome editing strategies are also progressing, although important biological and technical barriers remain, particularly for durable adrenal targeting. SUMMARY:The therapeutic landscape for CAH is evolving rapidly beyond conventional steroid replacement. These innovations may improve biochemical control and long-term outcomes, but challenges remain regarding adrenal crisis risk, long-term safety, durability, cost, and global equity of access.
