Contemporary Pediatrics most-viewed articles from April to July, 2023

1. Children and headaches: Red ­flags, triggers, and rescue treatments

Image Credit: © Jan H. Andersen - © Jan H. Andersen - stock.adobe.com.

Contemporary Pediatrics’ best-performing article over the last 3 months was “Children and headaches: Red flags, triggers, and rescue treatments,” written by Susy Jeng, MD. In the article, Jeng explained that headaches are 1 of the top 5 health problems of childhood, as at the time of publication in May 2021, 58.4% of children aged 1 month or older would develop headaches. Jeng explains the differences, red flags, and triggers between urgent vs nonurgent headaches. Red flag signs and symptoms for headache include: “new or quickly-worsening headache type, focal and side-locked headache, headache maximal at onset, infectious symptoms, pressure-dependent features, focal neurologic symptoms, and focal neurologic exam findings.”

Contemporary Pediatrics recently asked Jeng about any recent updates on the treatment of headaches in children. While she did not highlight any specific new treatments, she did observe, “There is no data on new red flags, but there is data on which red flags are most prognostic. A recent study pointed out that non-specific red flag factors (headache waking patients from sleep, headache on awakening, and headache increasing in frequency, duration, and severity) are unlikely to lead to a finding of emergent intracranial abnormality on neuroimaging. A separate study has noted that the diagnostic yield of the following red flag factors is high: acute onset (less than 3 months), altered mental status, focal motor abnormality, and ocular/pupillary abnormality or squint,” which may lead to more specific diagnoses from health care professionals, who can then determine the proper interventions.

According to the original article, some of the most common triggers for pediatric headaches are stress and anxiety, warm climate, and lack of sleep. General categories for lifestyle modifications include sleep regulation, daily exercise, stress reduction, and water and food intake. Recently, Jeng explained, “Lifestyle changes can play a major role in the reduction of headache, and lack of lifestyle changes may lead to intractable headaches. While specific food triggers and food allergies are not widely applicable to the general pediatric headache population, there is a significant body of literature linking obesity with headache severity and frequency. This is likely multifactorial- including a proinflammatory state, psychological factors, and a sedentary lifestyle. There is also literature that losing weight in obese adolescents with headaches can lead to a decrease in headaches.”

In relation to an increase in pediatric headache prevalence, especially amid the mental health crisis, Jeng recently told Contemporary Pediatrics, “There are no new studies looking at an increase in headache prevalence in all children during [the] COVID-19 [pandemic], but there are many studies pointing to an increase in headache prevalence for known pediatric headache patients. According to a recent survey of patients in a pediatric headache clinic, since pandemic onset they have experienced an increase in headache frequency, anxiety and mood disorders, a decrease in physical activity, and an increase in screen time.”

Click here to read the full article.

2. Chronic cough: Watch for “red flags”

Image Credit: © Krakenimages.com - © Krakenimages.com - stock.adobe.com.

When it comes to chronic cough, Bradley Chipps, MD, FAAP, wrote the article that acquired the second-most views from April to July titled “Chronic cough: Watch for ‘red flags.’”

Chipps notes children “in whom cough reflex hypersensitivity persists beyond 3 weeks may require evaluation.” Further, any child with cough persisting longer than 8 weeks should be evaluated.

Click through the table below to see key questions that can help determine the etiology of a particular cough.

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3. FDA approves semaglutide for obesity in adolescents

Image Credit: © maurice norbert - © maurice norbert - stock.adobe.com.

In December 2022, the FDA approved semaglutide (Wegovy; Novo Nordisk) to treat obesity in pediatric patients aged 12 years and older.

The mean percentage change in body mass index (BMI) the main outcome of a phase 3a clinical trial of semaglutide, was a 16.1% decrease for the semaglutide group compared to the placebo group (0.6%). In addition, 77% of patients taking semaglutide saw a BMI reduction of at least 5%, a secondary outcome in the study.

In June 2023, semaglutide products including Wegovy, an injection to help children 12 years and up with obesity lose and keep off weight, were listed on the FDA's drug shortages list. As a result, the FDA warned providers and patients of drug compounding amid these shortages. At the time of the warning in June, Wegovy 0.25 mg / 0.5 mL, 0.5 mg / 0.5 mL, and 1 mg / 0.5 mL were listed to have limited availability through September 2023.

As of September 12, 2023, the semaglutide injection was listed as "in shortage." Wegovy 0.25 mg / 0.5 mL, 0.5 mg / 0.5 mL, and 1 mg / 0.5 mL still have limited availability due to an increase of demand for the drug, and the estimated shortage duration is listed as "to be determined."¹

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4. Bone age assessments: What they can tell you about growth

When it comes to gauging growth rates, bone growth assessments can be useful. A specialized assessment for how much a child is expected to grow, when a child will enter puberty, and what the child's final weight will be can help pediatricians determine if there is any concern for disorders or conditions that could potentially affect growth, bone health, or development.

According to the article, there are several conditions that could contribute to delayed bone age, including:

Click here for the full article and more information.

5. Gastrointestinal disorders: Red flags and best treatments

According to an article written by Praveen S. Goday, BS, MD, the most common gastrointestinal (GI) ailments presented to pediatricians include abdominal pain, diarrhea, vomiting, constipation, failure to gain weight, and feeding issues. Take a look at each of these categories along with key takeaways from the article. Click the link after the recap for the full article on GI red flags and best treatments for more information.

Abdominal pain

Diarrhea

Vomiting

Constipation

Failure to gain weight

Feeding disorders

Click here for the full article.

Reference

1. FDA drug shortages. FDA. Revised September 12, 2023. Accessed September 27, 2023. https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Semaglutide%20Injection,%20Solution&st=c