Certainly 2020 turned out NOT to be the year many of us thought it would be. The date suggested visual acuity and a bright future, but it turned out to be the opposite, with images of masks, staggering statistics of deaths, the pervasive admonition to “socially distance,” and a sense of loneliness and isolation. None of this was on our radar screen in the spring of 2019 as we put together the 67th issue of Advances in Pediatrics updates and reviews on the challenging topics facing pediatricians. Fortunately, as we go to press in the spring of 2020, things seem to be improving, and the needs of children, beyond COVID-19, still need to be addressed. As in the past, the 2020 issue of Advances in Pediatrics covers the whole gamut of pediatrics. Assessing the social determinants of health, toxic stress, and adverse childhood experiences continues to be emphasized as critical to a child’s full medical evaluation. An underaddressed pediatric population are military-connected children and their unique needs, especially when they are cared for in civilian primary care settings. While these children are particularly vulnerable because of frequent moves and parental absences, all children can benefit from pediatric advice to caregivers about fostering strong attachments (the foundation of childhood resilience) and teaching positive parenting principles. And while COVID-19 became the infectious disease “du jour” with concerns about transmissibility, high mortality, the paucity of proven treatments, and the lack of a vaccine, we need to celebrate the remarkable progress made in addressing other infectious diseases, such as meningococcal infections and hepatitis C. Newer vaccines against Neisseria meningitidis have resulted in a dramatic decrease in the incidence of the disease in the United States. Similarly, the development of oral direct-acting antivirals has improved the management of hepatitis C in the pediatric population. Equally dramatic progress has been made in the management of sickle cell disease with the development of newer Food and Drug Administration–approved medications (L-glutamine, crizanlizumab-tmca, and voxelator) and the prospect of bone marrow transplantation and gene therapy. Of late, there has been a lot of interest in type 2 diabetes and its increased emergence in the pediatric population, particularly those who are obese. Importantly, there have been significant changes in the management of type 1 diabetes in children, including advancements in pump technology, continuous glucose monitoring, and “closed loop” insulin pump systems, which have revolutionized treatment. Changes in the age of puberty have also been recognized with both boys and girls entering puberty at an earlier age, placing an additional challenge on recognizing when development is precocious or simply a variation of normal. It is critical to make this distinction and not implement very expensive therapy to stop what may be normal pubertal progression. Urolithiasis, often thought of as an adult disorder, can also affect children. The condition can readily be assessed with ultrasound without a need for a computed tomographic scan. Metabolic disturbances are often the basis for kidney stones in the pediatric population.
Advances in surgery are equally noteworthy, including closing gastroschisis, managing inguinal and other hernias, dealing with ovarian masses and torsion (emphasis on salvaging the ovary), and the surgical approach to pulmonary and pleural disorders, such as empyema, CPAM (congenital pulmonary airway malformations), and pneumothorax. Engagement in sports is on the rise with children being younger and often participating in a single sport with the subsequent development of overuse syndromes. In many cases, judicious pediatric advice and prevention are key to reducing such syndromes. Although once dismal, the prognosis for Duchenne muscular dystrophy is much improved with new developments related to the diagnosis, treatment, and management that have redefined the disease prognosis, course, and life expectancy.
As I write this Introduction, we are in the spring of 2020, amidst the COVID-19 pandemic. However, it’s time to again plan for the 68th issue of Advances in Pediatrics and select subjects on which to report. Right now, it seems hard to believe there is interest in anything besides COVID-19, but there is. Fortunately, there continue to be new tools for diagnosis and new modalities for management. There will be new advances to report on as COVID-19 fades from the headlines.