The Link - June 2024

Although headache in the pediatric population is a common complaint in the primary care setting, little education on management is given to providers. Over 60% of children will complain of a headache, and about 8%-15% of children have migraines. Who should manage headaches? Primary care? Neurology? Both? This article aims to help the primary care physician feel more comfortable with pediatric headache and know when to refer their patient.

Readers of this column have likely heard about the outbreak of bird flu in dairy cattle that began earlier this year and the two associated human cases of HPAI (highly pathogenic avian influenza) A(H5N1). The affected people were both dairy workers that had conjunctivitis and apparently no other symptoms. Conjunctivitis has been known with avian influenza infections previously.
The “highly pathogenic” in HPAI refers only to effects of the virus in poultry, where these viruses cause severe disease and high mortality, and does not refer to their effects on mammals, where illness (if it occurs at all) will be variable.2 Since the original emergence in 1996 of HPAI A(H5 N1), many millions of wild birds and poultry have died from either direct infection or, in poultry, from culling to prevent ongoing transmission of infection. HPAI A(H5N1) was initially detected infecting domestic waterfowl in China. In 1997, the first human infections were noted in Hong Kong. It would go on to cause more than 900 human infections (most occurred prior to 2016) with a mortality rate around 50%. For a time, it was replaced in birds by H5N6 and H5N8 viruses, but in 2021 a new strain of HPAI A(H5N1) emerged in the Eastern Hemisphere. That strain started the current HPAI A(H5N1) wild bird outbreak in North America in March 2022. The first and, until recent events, only human case in the United States was noted shortly thereafter.

A 15-year-old male presents for evaluation of “zits.” He reports a one-year history of developing pimples on the cheeks, forehead and chin area. He is using an over-the-counter non-medicated facewash without improvement. He denies using anabolic steroids or supplements. He is not using any oral or topical steroids. He reports similar but less numerous lesions on the chest and back. He denies picking at his acne.
Question #1 - How would you grade the patient’s acne?

1. Clear

2. Almost clear

3. Mild

4. Moderate

5.  Severe

Globally, viral hepatitis infections result in 3,500 deaths each day. The World Health Organization (WHO) estimates that in 2022, there were 254 million people living with chronic hepatitis B. In 2022, 1.1 million deaths were caused by hepatitis B. Most of those deaths were from cirrhosis and hepatocellular carcinoma. It is estimated that there are 1.2 million new infections every year.

Pediatricians have long been allies both with parents and, in a developmentally appropriate manner, with children throughout the dynamic period of childhood into young adulthood. Without being an ally, pediatricians cannot truly engage with either parents or youth. The ethical importance of family-centered care requires attunement to the specific needs of a child within the context of their unique family while attending to their physical, behavioral and developmental wellbeing. And within the framework of ethically pursuing a child’s best interests, families and clinicians engage in a shared decision-making process that cannot be accomplished without allyship.

In a similar vein, pediatricians have long been advocates for children. Historically, great strides in public health, nutrition, disease and injury prevention have been made in child wellbeing. Pediatric clinicians have long given voice to those without a vote or other means to secure their future. Even today, the American Academy of Pediatrics holds formal “advocacy internships” to help pediatricians continue to speak up for children and raise their collective rights in safe, nurturing environments in which they are afforded access to education and health care.

Summertime is finally here! While warm weather brings opportunities for outdoor fun such as picnics, hiking and camping, we also observe a rise in tickborne infections. The Centers for Disease Control and Prevention (CDC) reports that emergency department visits for tick bites in the United States have increased significantly since April, especially in the Midwest. Recently, the Kansas Department of Health and Environment published a healthcare alert on the increased tick activity and reports of tickborne diseases in our area (accessed
here). Therefore, pediatric clinicians should be aware of the tips and tricks with treating tickborne infections.