International travel can be exciting but carries specific health risks if not appropriately planned. Primary care pediatricians should be prepared to provide timely, tailored pre-travel health counseling for families to ensure adequate time for necessary immunizations and prophylactic medications, in addition to ensuring routine vaccinations are up to date. Further counseling on risk-reducing behaviors and strategies to manage common travel-related health issues should also be provided. For patients who have medical conditions that may lead to an immunocompromised status, which may require specialized guidance or vaccines not routinely available in primary care, referral to a travel medicine clinician is indicated to optimize the patient's health and safety. Pre-travel counseling should also include guidance on recognizing and seeking care for acute illness after returning from travel to prevent serious morbidity and the spread of highly contagious infections.

Following cancer treatment, childhood cancer survivors (CCS) are at risk for adverse physical, psychosocial, functional, and behavioral long-term health outcomes, known as "late effects." Risk for late effects is individualized based on the survivor's treatment exposures and can occur years or decades after treatment. Lifelong survivorship care is needed for screening, prevention, and treatment of late effects. Studies have shown that survivor-focused care declines over time; however, survivors remain engaged with regular medical care. It is important for primary care health care professionals to be aware of resources when caring for this unique population. Multiple domestic and international guidelines are available to provide recommended evaluations for cancer survivors based on their treatment exposures. This review highlights important topics relevant for health care professionals caring for CCS, including organ system-specific late effects, psychosocial care, subsequent neoplasms, immunizations, and transition of medical care.

Advances in cancer treatment and supportive care have resulted in more than 80% of pediatric cancer patients surviving into adulthood. This progress has prompted consideration of factors influencing long-term quality of life for patients, including fertility. The ability to have biological children is important to many survivors. Yet, gonadotoxic therapies, such as alkylating agents and radiation, can damage gonadal tissues and cause infertility. Since these treatments remain essential for cure, efforts have expanded to better understand fertility risks and preservation strategies. Prominent organizations, including the American Society for Reproductive Medicine, American Society of Clinical Oncology, American Academy of Pediatrics, Association of Pediatric Hematology/Oncology Nurses, and Children's Oncology Group, recommend all cancer patients receive comprehensive counseling on fertility risks and options. This review outlines current knowledge on fertility risk, preservation strategies, care barriers, and future directions to improve fertility preservation access and outcomes for pediatric cancer patients and survivors.

Informed consent is a guiding principle underpinning medical care. In pediatrics, most patients are unable to provide consent by nature of their age and maturity, and the responsibility for providing informed permission falls to the child's parent or guardian. However, in most circumstances, the child should be involved in discussions about their medical care and sometimes can give assent to their care. In pediatric oncology, where clinical research is often enmeshed in clinical care, the processes of informed consent and assent may be even more complex. Pediatric oncology clinicians must be able to communicate the goals, potential benefits and risks, and anticipated side effects (of both routine care and involvement in research studies), while being attuned to the parents' or guardians' emotional state and understanding. While obtaining consent and assent can be complex and even challenging, familiarity with their ethical rationale is essential for pediatric clinicians.

Although survival rates for pediatric cancer diagnoses have improved significantly, persistent health disparities prevent many children and adolescents in the United States from reaping equitable benefit from this progress. This review examines inequities related to race and ethnicity, language preference, socioeconomic status, and geographic location. A literature search identified 33 articles highlighting how these factors intersect to affect diagnosis, treatment access, clinical trial participation, and outcomes. Black patients and Hispanic patients face consistently poorer survival, while language barriers are linked to delayed care and increased mortality. Low socioeconomic status and lack of insurance contribute to late-stage diagnoses and treatment nonadherence. Residence in rural areas or historically marginalized urban neighborhoods are associated with increased mortality. Disparities in clinical trial enrollment further limit access to cutting-edge therapies and weaken the generalizability of research. Addressing these disparities requires systemic reform, culturally informed care, and inclusive research practices to ensure equitable outcomes.

Deleterious changes in cancer predisposition genes can increase the risk for malignancy in children starting as early as birth. Pending the potential introduction of universal screening programs, in which all newborns may be tested for pathogenic/likely pathogenic variants in established susceptibility genes, coordination amongst health care professionals (including the pediatrician) is necessary to identify children with hereditary syndromes at a young age and to initiate surveillance. This review provides a high-level overview of cancers that are observed in the first year of life, genes known to confer germline predisposition, methods for cancer detection beyond the well-child examination, and areas of current research.

Eczema coxsackium, a more severe manifestation of hand, foot, and mouth disease, is primarily caused by coxsackievirus A6 and A16. It predominantly affects children with atopic dermatitis and is characterized by vesicular, bullous, and erosive eruptions on both active and inactive eczematous skin, including involvement of the oral mucosa, typically following a brief febrile prodrome. We report an atypical case of eczema coxsackium in an 8-month-old with a history of atopic dermatitis who presented with a widespread rash and prolonged fevers without typical oral lesions. The diagnosis of eczema coxsackium was made based on clinical findings and history. This illustrative case underscores the importance of considering eczema coxsackium in the differential diagnosis of viral exanthems, particularly in children with atopic dermatitis.

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) and gluten-free diets are increasingly used as both therapeutic and diagnostic interventions for pediatric patients with gastrointestinal disorders. The low FODMAP diet is primarily indicated for children with irritable bowel syndrome or disorders of brain-gut interaction when symptoms persist. Implemented in 3 phases (elimination, reintroduction, and personalization), the diet helps identify individual triggers and improve symptoms, such as bloating and abdominal pain. In contrast, the gluten-free diet is the cornerstone treatment for celiac disease. Accurate diagnosis and monitoring are important, as both diets carry nutritional and psychosocial risks. Primary care clinicians are responsible for identifying appropriate patients, coordinating evaluations, and monitoring adherence, growth, and well-being to ensure safe and effective use of these dietary interventions. Multidisciplinary collaboration with registered dietitians is important for growth monitoring, nutritional optimization, and both physician and patient support.

Dietary fibers are carbohydrates that are neither digested nor absorbed in the intestine. From regulation of blood glucose and cholesterol to treatment of constipation, irritable bowel syndrome, and inflammatory bowel disease, fiber has an important role in both disease prevention and treatment within the gastrointestinal system and beyond. The US Department of Agriculture's 2020-2025 Dietary Guidelines for Americans identify fiber as underconsumed across age groups, with many studies showing that dietary fiber intake is low in most children consuming a Western diet. Understanding which foods are rich in fiber is key to increasing intake; however, lack of variety in a child's diet can make it difficult to meet the daily recommended intake for dietary fiber. The purpose of this article is to review the importance of fiber in a child's diet, including disease treatment and prevention, and provide practical advice for clinicians and families about fiber intake for children.

Hepatitis-associated aplastic anemia (HAAA) is a rare but life-threatening disorder that requires early recognition and intervention. Pediatricians play a critical role in identifying cases where acute hepatitis transitions to severe bone marrow failure. This review presents the diagnostic and therapeutic complexities associated with HAAA, emphasizing the importance of a multidisciplinary approach. Key topics include the pathophysiology of immune-mediated marrow suppression, diagnostic strategies (eg, immunophenotyping, bone marrow biopsy), and management approaches (eg, immunosuppressive therapy, hematopoietic stem cell transplantation). The review also highlights emerging evidence on viral triggers, such as severe acute respiratory syndrome coronavirus 2, and underscores the need for heightened clinical awareness and standardized treatment strategies.

Human milk (HM) is the gold standard for infant nutrition, providing optimal components essential for growth, development, and immune protection. Many infants receive formula either partially or exclusively due to a range of medical, personal, or logistical reasons. This review outlines the nutritional composition of HM and discusses how infant formulas are designed to approximate its properties. Standard cow's milk formulas remain the most commonly used, but numerous specialized formulas, such as hydrolyzed, amino acid-based, and plant-based, offer tailored options for infants with specific medical or nutritional needs. Emerging preferences for European formulas and alternatives are also discussed, along with guidance on appropriate use and preparation. Ultimately, infants who are formula fed can achieve normal growth when provided with appropriately selected and prepared formulas under professional guidance. Understanding the composition, indications, and limitations of each formula type enables clinicians to support diverse feeding choices while promoting optimal infant growth and development.

Pediatric primary care clinicians are instrumental in addressing picky eating. While a normal part of human development, picky eating can lead to nutritional deficiencies and unnecessary stress if not managed properly. Picky eating occurs on a spectrum, from benign and age-appropriate issues (eg, neophobia) to pathologic feeding disorders (eg, avoidant/restrictive food intake disorder, pediatric feeding disorder). This article serves as a call to action for pediatric care teams to understand the nuances of picky eating and advocate for families struggling to feed their children. An action plan is proposed to determine picky eating severity that recommends baseline nutrition strategies with consideration to a child's accepted foods while conveying the need for specialist referral if there is no improvement. Pediatric care teams must utilize a compassionate and informed approach to support families navigating the stress of picky eating with a goal of positive mealtime experiences and optimized nutrition.

Youth who are transgender and gender diverse (TGD) experience metabolic conditions with differing rates than their peers who are cisgender. Mental health, minority stress, and related behaviors likely play a significant role in these differences. At the same time, the sex hormones (ie, estrogen and testosterone) play an integral role in metabolic health with sexual dimorphic patterns. Emerging research is evaluating the positive, negative, or neutral metabolic changes seen with gender-affirming hormonal therapy (GAHT) in adolescents and young adults. In this review, we summarize these findings, specifically evaluating five domains: (1) cardiovascular health, (2) lipid metabolism, (3) insulin resistance, (4) body composition, and (5) liver function. Using the available evidence, we highlight the baseline characteristics prior to GAHT, describe the expected changes with therapy, and review the current guideline-based screening recommendations while on GAHT for metabolic conditions.

Detransition refers to stopping, shifting, or reversing an initial gender transition. It often involves changes in self-identity and decisional regret with prior transition-related medical or surgical treatments. There are currently no formal care guidelines available to assist clinicians in discussing detransition with patients and their families or for supporting young people navigating the process. The aim of this article is to examine contemporary detransition research published between 2020 and 2025 to enhance evidence-informed care for adolescents and young adults who are transgender and gender diverse, as well as individuals who opt to detransition. Detransition often occurs in the context of health concerns or complications with treatments, transgender discrimination, complex mental health challenges and neurodivergence, and identity shifts. Recommendations for care and support for patients contemplating or engaging in a detransition process are discussed.

Pediatric asthma is a chronic inflammatory respiratory condition characterized by recurrent wheezing, chest tightness, breathlessness, and coughing, which can significantly impact quality of life and lead to hospitalization or long-term lung impairment. The prevalence of asthma has increased globally, with higher rates in urban areas and developing countries. Current management strategies emphasize inhaled corticosteroids (ICS) as the cornerstone of treatment, with long-acting beta 2-agonists (LABAs) introduced for patients requiring additional symptom control. ICS-LABA combinations have demonstrated efficacy in reducing exacerbations, improving lung function, and lowering health care utilization. However, concerns persist regarding adherence, potential masking of airway inflammation, and optimal dosing. The emerging maintenance and reliever therapy (MART) approach integrates ICS and formoterol into a single inhaler for both maintenance and symptom relief, aiming to enhance adherence and optimize treatment outcomes. This review examines the current evidence supporting ICS-LABA therapy and introduces MART as a potential alternative for pediatric asthma management.

Drowning is a leading source of mortality and morbidity in children. However, the vast majority of drowning deaths are preventable, and there are important actions that children, parents, and health care providers can take to reduce the risk of drowning in children.