Acquired brain injuries (ABIs), including hypoxic-ischemic and traumatic injuries, are leading causes of long-term disability in children. While acute treatment has advanced, many survivors face persistent cognitive, emotional, and physical challenges that require coordinated outpatient care. This review aims to equip pediatric providers with the knowledge and tools necessary to provide longitudinal, comprehensive, and family-centered outpatient care for children recovering from ABIs. This review begins with the definitions, etiologies, and prognostic factors associated with pediatric brain injury, followed by key components of outpatient assessment, including symptom monitoring, appropriate use of diagnostic tools, and identification of early warning signs for complications. This review then highlights common neuropsychological impacts-such as deficits in memory, attention, and executive functioning-as well as emotional and behavioral concerns including anxiety, depression, and social withdrawal. Musculoskeletal complications and tone abnormalities are discussed alongside strategies for outpatient treatment. The roles of physical, occupational, and speech therapy are explored, with emphasis on collaborative, goal-directed care that extends into school and community settings. Finally, ongoing gaps in outpatient care are identified and examined, particularly in terms of access and continuity of services.
Peptic ulcer disease (PUD) in children, while less prevalent than in adults, poses significant diagnostic and therapeutic challenges because of age-specific presentations and pathophysiology. This review addresses the epidemiology, etiologies, clinical manifestations, and management strategies of pediatric PUD, with particular emphasis on Helicobacter pylori-associated and non-H pylori ulcers. The review outlines the limitations of applying adult-based "test-and-treat" strategies to children and underscores the importance of guideline-directed endoscopic evaluation and targeted therapy. The review also explores emerging antibiotic resistance patterns, appropriate use of acid therapy, and follow-up protocols to confirm H pylori eradication. Distinct pediatric considerations, including age-appropriate diagnostics, medication dosing, and caregiver education, are discussed. Additionally, the review presents updated guidance from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and European Society for Paediatric Gastroenterology Hepatology and Nutrition to aid clinicians in tailoring care. By synthesizing recent advances and best practices, this review aims to enhance recognition, reduce inappropriate testing, and improve outcomes in children affected by PUD.
Pediatricians spend a substantial part of patients' visits counseling on development and behavior. In many cases, the root of behavioral challenges is the relationship between the child and their caregiver. Pediatricians need to know the signs of unhealthy relationship patterns that indicate the need for more resources other than the usual anticipatory guidance. This article reviews the attachment patterns that a child can form with their caregiver, detailing the characteristics of secure and insecure relationships. This article also describes the conditions in which a disorder of attachment or of social engagement can present and how to identify and properly manage these disorders.
Leg length discrepancy (LLD) is a frequently encountered yet often underrecognized musculoskeletal condition in children. Minor differences in leg length are common and typically benign; however, more significant discrepancies may reflect underlying congenital, developmental, or acquired pathology. Because many children adapt well, these discrepancies can remain unnoticed until gait changes, pain, or functional limitations appear. Early recognition is essential, as management depends on the child's remaining growth and the underlying cause. Epidemiologic studies suggest that up to 90% of children have some degree of asymmetry, but clinically significant LLD is rare. Despite this, many pediatricians report uncertainty about how to distinguish true from apparent discrepancies and when to refer for orthopedic evaluation. The optimal approach involves routine screening during well-child visits, accurate physical examination, and timely referral when progressive or symptomatic differences are detected. This review summarizes the causes, evaluation, and management of pediatric LLD and provides practical guidance to help pediatricians recognize red flags, interpret imaging, and counsel families effectively.
Hantaviruses are rare but deadly pathogens. New World hantaviruses, primarily present in North and South America, cause hantavirus cardiopulmonary syndrome, which leads to death in up to one-third of affected patients. Old World hantaviruses, primarily endemic to Europe and Asia, cause hemorrhagic fever with renal syndrome and, dependent on the specific hantavirus, may cause death in up to 15% of patients. A heightened clinical suspicion is important for diagnosis of these conditions because important epidemiologic clues may exist at the time of presentation. A variety of testing modalities exist, from evaluation of blood smears (for hantavirus cardiopulmonary syndrome and may be available at many rural clinics) to serological evaluation and polymerase chain reaction testing (available at tertiary care centers or as a send-out to a reference laboratory). Despite the absence of proven antiviral therapies for many of these viruses, supportive care present at tertiary-level medical centers including invasive cardiovascular monitoring, mechanical ventilation, and access to dialysis (for hemorrhagic fever with renal syndrome) and extracorporeal membrane oxygenation (for hantavirus cardiopulmonary syndrome) may improve outcomes. Given the high risk of death as well as the potential for these patients to decompensate rapidly over 24 hours, early recognition of hantavirus infections and transfer to a tertiary medical center is imperative. The nonspecific prodrome, which mimics more common viral illnesses ubiquitous in children, as well as a more rapid progression to death in children than adults with hantavirus cardiopulmonary syndrome, highlights the need for pediatricians to remain vigilant for this rare and dangerous disease.
Abstract Oncologic emergencies are potentially life-threatening complications that require timely identification and intervention. Although these events are relatively uncommon, they pose significant risks for morbidity and mortality in children with cancer. This review focuses on five of the most critical oncologic emergencies encountered in pediatric practice: febrile neutropenia, hyperleukocytosis, spinal cord compression, tumor lysis syndrome, and superior mediastinal/superior vena cava syndrome. Each presents with a variable constellation of signs and symptoms that may mimic more benign illnesses, underscoring the importance of maintaining a high index of suspicion. Delays in recognition and treatment can result in rapid clinical deterioration, but with prompt supportive care and disease-directed therapy, outcomes can be significantly improved. This article provides a concise, practical overview of the pathophysiology, diagnostic approach, and initial treatment of each condition, with the goal of equipping general pediatricians and frontline providers with the tools necessary to identify these emergencies early and initiate appropriate care.
