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Pediatric inflammatory bowel disease (IBD) is a chronic, life-threatening gastrointestinal tract disease that usually involves the terminal ileum, cecum, colon, and perianal area. There has been a growing incidence of IBD reported worldwide, and it is becoming an increasing concern for pediatric health care. This discussion covers the global significance, the subtypes, diagnostic criteria, and advances in pediatric IBD management. [ABSTRACT FROM AUTHOR]

There are certain concepts of abuse that are unique in the adolescent and young adult age groups. In this review paper, a number of these concepts are discussed including: epidemiology, risk factors, consequences of abuse, concepts of screening, adolescent males as perpetrators of abuse, and management of abuse, including with pharmacologic agents. [ABSTRACT FROM AUTHOR]

History has taught us that children with disabilities in general are at an increased risk of child maltreatment. The maltreatment may cause additional disabilities. Furthermore, child maltreatment as an adverse childhood experience has been linked to leading causes of adult morbidity and mortality. In this paper, the international disability prevalence is reviewed as well as the connection between disability and maltreatment. Stigma, discrimination and ignorance regarding disabilities are factors which place people with disabilities at higher risk for violence. Prevention and early detection are therefore important public health aspects in this regard. [ABSTRACT FROM AUTHOR]

The quest for understanding the pathophysiology and management of hepatobiliary disorders has taken Homo sapiens thousands of years. The liver was viewed in religious terms at first and as designated priests utilized divination practice to predict the future, lasting lessons of anatomy were learned. The liver was viewed in various ways, including as the center of one's life and/or the place of negative emotions (anger, greed, jealousy). Gallstones were described by Galen and Alexander of Trailles. Knowledge of anatomy led to etiologic understanding of hepatobiliary disorders and eventually methods of treatment emerged over the passing millennia. This discussion considers some of the polyglottic pantheons in this regard, including Galen of Pergamon (AD 129-c.200/c.216), Avicenna (980-1037), Andreas Vesalius (1514-1564), Francis Glisson (1597-1677), Giovanni Battister Morgagni (1682-1771), René Théophile Hyacinthe Laënnec (1781-1826), Claude Bernard (1813-1878), Henry W. Gray (1827-1861), Karl Wilhelm von Kupffer (1829-1902), Tadeusz Browicz (1847-1928), Johann Ludwig Wilhelm Thudichum (1829-1901), Samuel Alexander Kinnier Wilson (1878-1937), Frank H. Netter (1906-1991), and other sages of surgery and medicine. Much has been learned from the Greek myth of Promethius to the prodigious pantheons of progress in the past and present. [ABSTRACT FROM AUTHOR]

Homo sapiens may have emerged from complex and miraculous origins 300,000 years ago, and sophisticated speech may have emerged many millennia later. Changes in speech development, such as the FOXP2 gene around 100,000 years ago, led to remarkable speech patterns in these humans that allowed verbal passage of learned information from generation to generation. Wandering humans finally began to settle down with the development of agriculture over 10,000 years ago in various places in the world that include the near East, Africa, China, and Southeast Asia. Knowledge gained over the past 10 millennia regarding gastrointestinal disorders in humans is now reviewed from a historical perspective and beginning in Mesopotamia. [ABSTRACT FROM AUTHOR]

In the quest for winning the game, some athletes take various chemicals (ie, drugs, herbs, or supplements) in attempts to develop greater strength, endurance, or other elements that bring a competitive advantage. There are more than 30,000 chemicals sold throughout the world with unrestrained and unproven claims; however, some athletes consume them with hopes of increasing their athletic abilities, often without knowledge of the potential adverse effects and with limited evidence of efficacy. Complicating this picture is that research on ergogenic chemicals is typically conducted with elite adult male athletes and not with athletes who are in high school. A few of these ergogenic aids include creatine, anabolic androgenic steroids, selective androgen receptor modulators, clenbuterol, androstenedione, dehydroepiandrosterone, human growth hormone, ephedrine, gamma hydroxybutyrate, caffeine, stimulants (amphetamines or methylphenidate), and blood doping. In this article, we describe the purpose of ergogenic aids as well as the potential side effects. [Pediatr Ann. 2023;52(6):e207–e212.] [ABSTRACT FROM AUTHOR]

Substance use disorders are a major public health conundrum of adolescents and adults throughout the world. The major problem of addiction in the world has intensified since the unfortunate biochemical isolation of cocaine, heroin, and morphine in the 19th century. The role of pharmacologic agents in the management of substance abuse disorders in adolescents is secondary or adjunctive, with psychological (psychosocial) therapies serving as the primary methods of treatment. Medications may serve a more primary role in the transient issue of helping in acute management of drug intoxication or withdrawal states. This review discusses current pharmacologic management of specific illicit drugs in which research indicates drug treatment can be beneficial; these drugs include alcohol, heroin, and cocaine. [ABSTRACT FROM AUTHOR]

Marijuana (cannabis) remains a controversial drug in the 21st century. This discussion considers current research on use of cannabis sativa and its constituents such as the phytocannabinoids. Topics reviewed include prevalence of cannabis use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis use disorders and withdrawal is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be further clarified as the 21st century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public often confused by a mediadriven false message and promise of benign pot consumption. Caveat emptor! [ABSTRACT FROM AUTHOR]

Substance use and abuse remains a major public health issue of adolescents throughout the world, including the United States. Encouragement by the media, peers, and many adults along with easy access to drugs of all types continues to lure countless millions of youth into use and abuse of many drugs. Results of the 2019 US Centers for Disease Control and Prevention Youth Risk Behavior Surveillance notes that there is significant abuse of drugs including illicit drugs but also prescription medications including stimulants, synthetic narcotics, and "recreational" cough syrups and several more emerging as we write. This discussion considers various drugs, including tobacco, alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, and some of the designer drugs. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 4-8% of the population in children, adolescents and adults. Aspects of ADHD can persist from childhood and adolescence into adulthood in 50% to 70% of persons with this DSM-5 disorder. Co-morbidities are common in persons with ADHD and must be considered in the overall therapy plan. Management considerations include behavioral-psychology therapy typically along with psychopharmacology. Nonpharmacological approaches to ADHD include placement in appropriate educational classes, social skills training, biofeedback, parental training, occupational training, physical therapy, and psychological therapy as needed in an individualized approach. Psychopharmacology can include psychostimulants, alpha-2 agonists, a norepinephrine reuptake inhibitor, and others. Careful, long-term management is important for pediatric persons with ADHD and co-morbid conditions that may be present. [ABSTRACT FROM AUTHOR]

This discussion considers two of the disorders found in the 2013 DSM-5 category of disruptive, impulsive control and conduct disorders: oppositional defiant disorder and conduct disorder. Features reviewed include definitions, clinical features, epidemiology, and principle of management. Both conditions have co-morbid conditions and oppositional defiant disorder may eventually become conduct disorder while conduct disorder may become antisocial personality in adulthood. [ABSTRACT FROM AUTHOR]

Aggression, aggressive behaviors, and violence are common phenomena in human beings including children, adolescents, and young adults. Aggression is a symptom of various disorders that can be medical, psychiatric, and combinations of these categories, such as substance use disorders. This discussion provides definitions of aggression and violence as well as looks at etiologic concepts. Management of aggression depends on the underlying contribution disorders and includes behavioral approaches as well as potentially, pharmacologic interventions. [ABSTRACT FROM AUTHOR]

Human sexuality is a complex phenomenon involving the interaction of one's biologic sex, core gender identity, and gender role behavior. Successful completion of normal stages of sexuality development is important for children and adolescents to enhance optimal life as an adult. Controversies arise for clinicians as they work with their pediatric patients regarding health care sexuality issues. It is important that clinicians help these patients in an unbiased and neutral manner. As adults, these children and adolescents will function in a number of sexuality roles, whether heterosexual, homosexual, pansexual, or other. This discussion considers many of these complex and critical issues that involve the fascinating development of human sexuality in pediatric patients. [ABSTRACT FROM AUTHOR]

Learning disabilities are a common problem seen in pediatric practice and the functional impairments can range from mild to severe. Learning disabilities are generally associated with many other behavioral symptoms and can affect the individual into adulthood. Early recognition and intervention have significant impact in long-term positive outcomes for children and adolescents who have learning disabilities. These interventions include medical, behavioral and academic forms of treatment. This discussion provides a broad conceptual overview of learning disabilities. [ABSTRACT FROM AUTHOR]

Incontinence disorders are an important group of problems clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, general clinical approach to enuresis, laboratory evaluation, and general principles of management. [ABSTRACT FROM AUTHOR]

Tics are one of the most common neuropsychiatric disturbances in children and adolescents. This paper reviews tic disorder definition, epidemiology, differential diagnosis, and co-morbidity. The major emphasis is on current principles of psychopharmacologic management of tic disorders in children and adolescents. Chronic motor tic disorder and Tourette's syndrome typically require the use of psychopharmacologic agents that traditionally have included haloperidol, pimozide, and clonidine. Risperidone and aripiprazole are now preferred by many to haloperidol. A variety of other medications have been used to ameliorate tics, but with less anecdotal and research support. The safe and effective treatment of Tourette's disorder, and other tic disorders, is based on a logical hierarchy of interventions, from cognitive and behavioral therapies to pharmacologic agents. Thus, it is important for clinicians caring for pediatric patients to have knowledge of the various medications used to ameliorate tics. [ABSTRACT FROM AUTHOR]

This discussion presents current research findings on postpartum depression (PPD) in the adolescent female. PPD is defined and then the etiopathogenesis of PPD are reviewed. Emphasis is placed on screening by the primary care clinician to identify this condition and issues in this regard are discussed. PPD management is considered including both non-pharmacologic and pharmacologic approaches. Recent research on PPD in the adolescent is presented. It is the recommendation of the authors that primary care clinicians become more knowledgeable about PPD to make an early identification and suggest effective means of management to reduce the devastation PPD can cause in the young mother, her newborn baby, and her family in general. [ABSTRACT FROM AUTHOR]

Gynecologic features of eating disorders include relationships to puberty, fertility effects, and the low estrogen underpinnings of eventual osteopenia as well as osteoporosis. It is concluded that clinicians should provide judicious observation for potential eating disorders in pubertal females along with prompt management of anorexia nervosa, bulimia nervosa, or other eating disorders that may be arise in children, adolescents and adults. [ABSTRACT FROM AUTHOR]

Obesity is a major risk factor for child, adolescent and adult health. Though diet and exercise are the cornerstone of obesity prevention and treatment, many pediatric persons do not adhere to a nutrition-exercise approach. This review reflects on concepts of pharmacology for the management of obesity in children and adolescents in the early 21st century. Medications considered in the management of obesity include sympathomimetics (with or without topiramate), serotonin agonists, fat blockers (gastrointestinal lipase inhibitors), glucagon-like peptide 1 (GLP-1) agonists, antidepressant/opioid antagonist combination and others. Medications that were used for obesity management and later pulled from the market are also discussed. There are two drugs, orlistat and liraglutide, approved by the United States Food and Drug Administration (US-FDA) for adolescents ≥ 12 years of age with obesity. In the pediatric population there remains limited evidence on the safety and efficacy of anti-obesity medications used in adults and close monitoring for adverse effects is needed. The use of medications to assist in the management of overweight and obesity in pediatric and adult persons will increase as the 21st century continues. Clinicians should be vigilant about the current state of the art with regard to pharmacology of obesity and to its future. [ABSTRACT FROM AUTHOR]

Eating disorders are complex biopsychosocial disorders that include anorexia nervosa and bulimia nervosa. This review considers both of these disorders with the emphasis on anorexia nervosa and its effects on adolescent females. Concepts of epidemiology, etiology, differential diagnosis, and management are considered. Particular emphasis is given to gynecologic and psychologic effects of anorexia and their management. Clinicians including those involved in adolescent gynecology can be very beneficial to these patients if the condition is recognized early and comprehensive, team-based care is provided. [ABSTRACT FROM AUTHOR]

Sexual abuse of infants, children, and adolescents remains a cataclysmic phenomenon in all societies and cultures in the world. Sexual abuse by a family member is a subset of this perplexing problem which has historical roots dating back to the dawn of human civilization. This reflection provides a context on this unfortunately common phenomenon in all cultures with major psychological consequences for the pediatric victim that lasts a lifetime. Prevention is the key to this tragedy and long-term therapy for the child or adolescent who has had this sacred trust destructively broken by a family member (s). [ABSTRACT FROM AUTHOR]

Sexual abuse of infants, children, and adolescents remains a cataclysmic phenomenon in all societies and cultures in the world. Exact numbers are not known, but the medical and psychological toll exacted on these pediatric victims is staggering and tragic. This paper provides perspectives regarding the effects of rape and molestation that these young individuals must endure including a lifetime of psychological sequelae and death. Treatment is difficult and problematic, while the key is understanding of underlying issues and efforts for prevention. [ABSTRACT FROM AUTHOR]

The literature of Homo sapiens and research by scientists have attested to the high frequency and the severe consequences of sibling abuse seen in families around the world. Often hidden or ignored by society, such exploitation is the most common form of abuse found in humans. Underpinnings to this phenomenon of desecration of our children are many, but tend to focus on family dysfunction, lack of education in parenting provided to most parents, and the underlying violent nature of humankind. This discussion presents concepts of sibling abuse found in all societies for thousands of years that has been hinted at in children's fables and finally studied by research in the 20th and 21st centuries. [ABSTRACT FROM AUTHOR]

Deliberate self-harm (DSH) is a common and typically secret phenomenon in adolescents, especially females that involves two main features--self-derogation and negative emotionality. Causes of non-suicidal selfinjury include attempts to get help from professionals, express disgust or self-anger, resist suicidal thoughts, and correct episodes of dissociation. DSH is associated with eating disorders and alcohol abuse, as well as other illicit drug abuse. Fortunately, most self-cutters are not at high risk for eventual suicide; however, all those with DSH histories should be carefully assessed for suicide as well as offered comprehensive management. Programs for prevention of suicide should be implemented for adolescents at risk for suicide and this includes those with histories of DSH. [ABSTRACT FROM AUTHOR]

Humans have been mystified by suicide perhaps from the earliest oral and written accounts of Homo sapiens. This article considers a variety of issues with reference to suicide in adolescents and young adults including its history, epidemiology, suicide risk factors, neurobiology, and management concepts. Suicide remains a major cause of death in adolescents and young adults but is a preventable condition in most cases if society provides principles of known prevention and mental health management. [ABSTRACT FROM AUTHOR]

Homosexuality has been a form of sexuality placed in the center of controversy of homo sapiens existence for countless millennia. The removal of homosexuality as a psychiatric illness by the American Psychiatric Association and the American Psychological Association in the 1970s changed the paradigm for perceiving gay and lesbian individuals. Views in the United States mental health community changed from linking homosexuality to psychiatric disorders over four decades ago to identifying depression and suicidality in gay and lesbian persons because of societal insouciance, impuissant aesculapian response, and implacable sacerdotal dogma. This article reviews issues involving the LGBT population and suicidality. [ABSTRACT FROM AUTHOR]

The first steam-powered vehicle is attributed to Ferdinand Verbiest in China made in 1672 for the Kangxi Emperor. The first recorded automobile death was Mary Ward in Ireland who was thrown from a steam-powered car and fell under its wheels in 1869. The first person killed in the United States is recorded as Henry Bliss in New York City on Wednesday, September 13, 1899. As the automobile became popular among all groups of humans, motor vehicle crashes became the major cause of death and disability among children and adolescents. Research initially focused on the physical trauma that motor vehicle accidents or crashes induced, but eventually the psychological toll of motor vehicle crashes (MVCs) in the pediatric population became appreciated. This discussion reflects on how this occurred taking the entire 20th century to be acknowledged by researchers, clinicians, parents, and the general society. [ABSTRACT FROM AUTHOR]

Aggression, aggressive behaviors, and violence are common phenomena in human beings including children, adolescents, and young adults. Aggression is a symptom of various disorders that can be medical, psychiatric, and combinations of these categories, such as substance use disorders. This discussion provides definitions of aggression and violence as well as consideration of etiologic concepts. Management of aggression depends on the underlying contribution disorders and includes behavioral approaches as well as potentially, pharmacologic interventions. Aggression in humans leads to severe consequences in the victims including turbulent trauma and even death. [ABSTRACT FROM AUTHOR]

The motor vehicle crash is the main cause of death and destruction in children and adolescents. One of the major psychological consequences to those who survive a motor vehicle crash (MCV) is post-traumatic stress disorder (PTSD). This discussion considers the future of research in this field that may also involve the use of artificial intelligence in control of motor vehicles that will take human error out of motor vehicle operation. It is important to consider all means in lowering the death and destruction faced by our children and adolescents on the killing fields of the roads in the United States and the world. [ABSTRACT FROM AUTHOR]

This review considers the teenage driver and the high risk of injury as well as death that these young drivers represent for themselves and others because of automobile crashes in the United States and around the world. Research suggests that half a million teenagers will die as motor vehicle drivers or passengers in the 21st century, that 35 million adolescents will be injured as drivers in the 21st century, and untold millions of car passengers are at risk of death and/or injury when exposed to teenage drivers in this century. Reasons for the high prevalence of motor vehicle crashes with injuries and deaths are considered as well as measures that have been instituted over the past few decades to improve this situation. From a viewpoint of prospicience, it is hoped that more preventive measures along with more research will help to reverse this tragic trend in the 21st century [ABSTRACT FROM AUTHOR]

Medical practitioners must face the reality that over 53,000 children and 3,000 adolescents succumb annually to one or more chronic illnesses. These deaths may occur while these precious patients are under direct clinical care in the hospital, often within the neonatal or pediatric intensive care units. No one is prepared for such tragic events--neither the patient, nor the family, nor hospital staff. This article considers the complex issues related to the hospitalized dying adolescent and offers recommendations for the staff that may help with the difficult task of ensuring that the deaths of young patients are peaceful, dignified, and painless. [ABSTRACT FROM AUTHOR]

Palliative care is defined by its Latin root word, palliare, which means "to cloak". Caring for infants whose medical abnormalities prevent a cure involves palliative care with attempts to ameliorate or ease the suffering that this vulnerable patient experiences, because of the medical state, which is present as well as potential effects of modern medical technology. This paper considers basic principles of such care and emphasizes that it must be conducted by an experienced, professional healthcare team, who are educated in principles of palliation and ethics, who work closely with the parents (family), and keep the best interests of this defenseless patient in mind at all times. [ABSTRACT FROM AUTHOR]

Some children and adolescents experience death at an age where they may be considered to have many years ahead of them. The exact cause(s) of pediatric death is widely variable and subject to many factors that include, for example, where the child lives - whether in a developing country or a developed country. Research by the World Health Organization reviewed 2000-2003 data on child death and concluded that 73% of the 10.6 million annual deaths in children under five years of age were due to six causes: Pneumonia (19%), diarrhea (18%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), malaria (8%) and birth asphyxia (8%). As we reflect on causes of death in our children, methods of prevention become critically important to research and implement. Research notes that millions of childhood injuries result in thousands of deaths. Death can be due to medical disease and considerable progress including prevention of death has been made in management of cancer and other conditions over the past century, especially in developed countries. It is also important to apply principles of management and prevention to consequences of aggression and chronic illness. We must look at underlying issues and should apply known principles of preventive medicine that are being researched in the 21st century to prevent needless deaths in our pediatric population. Prevention may arise from such understanding and application of known concepts with less pediatric deaths and fewer parents/families undergoing heart-breaking grieving processes. [ABSTRACT FROM AUTHOR]

Adolescent abortion remain a challenging and controversial topic in the 21st century complicated by the large number of teen pregnancies that remain unintended and the political crisis abortion represents in the American geo-political milieu. This discussion considers principles of pregnancy termination of pregnant youth. Approximately one million abortions occur annual in the United States to females of reproductive ages amidst intense socio-political-spiritual conflicts. As discussed there can be medical and surgical abortion in the first and second trimester of pregnancy. Pregnancy termination that is accomplished with trained clinicians may result in complications at a 2% rate or less; most of these complications are minor and include pain, bleeding, infections and anesthesia-related issues. Serious complications are rare but may occur, including major bleeding, disseminated intravascular coagulation (DIC), septic abortion, failed abortion, laceration of the cervix, atony or perforation of the uterus, and bowel/bladder injury. The best outcomes arise from proper counseling of a pregnant female who remains under well-trained clinical supervision. Following an established protocol is recommended; also, providing post-abortion counseling as well as proper contraception (long-acting reversible contraception; LARC) is also recommended for the person choosing abortion versus continuing her pregnancy. The geopolitical, socioeconomical, religious and complex complications of current 21st century factors mandates that caring clinicians continue to provide guidance and empathy to young persons dealing with issues of pregnancy and abortion. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder identified in 4% to 8% of children, adolescents, and adults. Features of ADHD found in childhood and adolescence persist into adulthood in as many as 70% of pediatric patients with this diagnosis. Various behavioral therapies are helpful for ADHD. This discussion focuses on medications that research has shown to be beneficial for treating the core features of this condition. Drugs that are approved by the US Food and Drug Administration for ADHD are psychostimulants (methylphenidate and amphetamine products), long-acting alpha-2 agonists (clonidine, guanfacine), and a selective norepinephrine reuptake inhibitor (atomoxetine). Clinicians prescribing these drugs should monitor their patients for both beneficial and adverse effects. Although it is often difficult to find a specific medication that is superior to others for all people with ADHD, research does show that methylpheni-date is typically superior to amphetamines. Thus, careful clinician scrutiny is needed to find the optimal formulation for those taking these medications. [Psychiatr Ann. 2021;51(10):459–466.] [ABSTRACT FROM AUTHOR]