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Hey, doctor, I want to tell you something!\" For 54 years, kids have shared with pediatrician Arnold Tanis stories, questions, and bold pronouncements about their childhood worlds. In between treating them, the good doctor wrote many of them down. Three generations of patients offer memorable and downright funny observations and opinions about all sorts of things: shots, school, their brothers and sisters, growing up, and even Dr. Tanis himself and whether he can sing as well as he thinks he does. The parents also chime in, both to complain about all their kids put them through and to celebrate how well they eventually turn out.A tireless, lifelong advocate of child safety, Dr. Tanis's impact on his patients and their families spans decades. This book is a testament to his career and a memorable glimpse of the warm and sometimes crazy world of a singing pediatrician.

Background: Decision-making concerning the treatment of choroid plexus tumor (CPT) in pediatric patients remains a topic of considerable debate. The aim of this work was to describe clinical features and prognostic risk factors of CPT in the pediatric population and to provide theoretical opinions regarding clinical decisions for CPT. Methods: The data of 96 patients with CPT and younger than 14 years were retrospectively analyzed. Clinical characteristics such as pathological type of CPTs, rate and severity of hydrocephalus, treatment and outcome, and recurrence were investigated. For categorical variables, the Pearson's Chi-square test was performed. The Mann-Whitney U-test was used for comparisons between nonnormally distributed parameters. Log-rank test was used for progression-free survival (PFS). Results: The study included 70 choroid plexus papilloma (CPP) cases, 17 atypical choroid plexus papilloma (aCPP) cases, and 9 choroid plexus carcinoma (CPC) cases. Compared with patients with CPP or aCPP, patients with CPC had a shorter disease course (median: CPP, 4 months; aCPP, 2 months; CPC, 1 month; H: 23.5, P < 0.001), higher rate of acute hydrocephalus (CPP, 27.1%; aCPP, 52.9%; CPC, 77.8%; χ2 = 10.9, P < 0.05), and lower incidence of cure rate (CPP, 85.7%; aCPP, 70.5%; CPC, 33.3%; χ2 = 13.5, P < 0.05). The severity of hydrocephalus with tumor in the lateral or third ventricle was significantly higher than that with tumors in the fourth ventricle (severe hydrocephalus: lateral ventricle, 51.7%; third ventricle, 47.0%; fourth ventricle, 11.1%; χ2 = 26.0, P < 0.001). Patients with gross total surgical resection had no better PFS than those with partial resection because of the use of adjuvant therapy in the latter (χ2 = 4.0, P > 0.05). Patients with CPC experienced shorter time for recurrence than those with CPP or aCPP (χ2 = 40.1, P < 0.0001). Conclusions: Our results indicated that CPP in the fourth ventricle could trigger serious clinical symptoms at an early stage, requiring early intervention. Adjuvant treatment might be necessary for patients with partially resected CPP, aCPP, and CPC to achieve a favorable outcome.

Background Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used. Methods The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results. Results We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis ( n  = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis ( n  = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics. Conclusions Despite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics.

(1) Background and Objectives: The COVID-19 pandemic has considerably affected clinical systems, especially the emergency department (ED). A decreased number of pediatric patients and changes in disease patterns at the ED have been noted in recent research. This study investigates the real effect of the pandemic on the pediatric ED comprehensively by performing a systematic review of relevant published articles. (2) Materials and Methods: A systematic review was conducted based on a predesigned protocol. We searched PubMed and EMBASE databases for relevant articles published until 30 November 2021. Two independent reviewers extracted data by using a customized form, and any conflicts were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. (3) Results: A total of 25 articles discussing the impact of COVID-19 on pediatric emergencies were included after full-text evaluation. Geographic distribution analysis indicated that the majority of studies from the European continent were conducted in Italy (32%, 8/25), whereas the majority of the studies from North America were conducted in the United States (24%, 6/25). The majority of the studies included a study period of less than 6 months and mostly focused on the first half of 2020. All of the articles revealed a decline in the number of pediatric patients in the ED (100%, 25/25), and most articles mentioned a decline in infectious disease cases (56%, 14/25) and trauma cases (52%, 13/25). (4) Conclusions: The COVID-19 pandemic resulted in a decline in the number of pediatric patients in the ED, especially in the low-acuity patient group. Medical behavior changes, anti-epidemic policies, increased telemedicine use, and family financial hardship were possible factors. A decline in common pediatric infectious diseases and pediatric trauma cases was noted. Researchers should focus on potential child abuse and mental health problems during the pandemic.

Objective: To determine the sensitivity, specificity and diagnostic accuracy of electroencephalography in predicting the development of a second/recurrent seizures/epilepsy within one year of first attack, in children who have developed their first unprovoked seizure. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Rawalpindi, Pakistan from Jan to Dec 2022. Methodology: This study was conducted on 126 paediatric patients who reported with a first unprovoked seizure. All patients aged between 4 and 12 years, of both genders. All participants underwent the recording of an EEG, for thirty minutes with photic and hyperventilation stimulation. All patients were followed-up for a period of one-year. Results:   Mean time from onset of seizure to presentation was 22.89±13.37 hours. An abnormal EEG was seen in 57(45.2%) patients: seizure activity was seen in 11(8.7%) cases, focal and generalized spike-waves in 11(8.7%) and 10(7.9%) cases, respectively, while slowing was seen in 31(24.6%) cases. Seizure recurrence was seen in 66(52.4%) cases. An abnormal EEG as a predictor for the development of recurrent seizures/epilepsy in children, who have had their first episode of unprovoked seizure, had a sensitivity of 57.58%, a specificity of 68.33%, a positive predictive value of 66.67%, a negative predictive value of 59.42% and a diagnostic accuracy of 62.70%. Conclusion: Electroencephalographic findings alone in paediatric patients suffering from their first unprovoked seizure carries inadequate sensitivity, specificity and diagnostic accuracy in predicting the development of future seizures.

Background: Supraglottic airway devices now have an established place in pediatric anesthesia practice. The laryngeal tube suction (LTS) II, a recent revision of the LTS, has very few studies evaluating its use in pediatric patients. The aim of this study was to compare insertion and ventilation profiles of the LTS-II size 2 and the ProSeal™ Laryngeal Mask Airway (PLMA) size 2 in pediatric patients undergoing elective surgeries. Materials and Methods: A randomized prospective study was conducted in 100 children aged 2-5 years between 12 and 25 kg weight, of the American Society of Anesthesiologists physical status I and II scheduled for routine elective surgeries of <90 min duration. They were randomly divided into two groups of 50 each, depending on the device inserted, and a standard protocol for anesthesia was followed. Outcome measures were studied in terms of ease and time of insertion, oxygen saturation (SpO2), oropharyngeal seal pressure (OSP), and ventilation failures. Results: Both groups were well matched in terms of age, weight, and type of surgery. The success rate for the first attempt was 90% for both the LTS-II group and PLMA group. Insertion was found to be easy in the majority of cases in both groups, and there was no statistical difference in blood pressure, heart rate, or SpO2 on insertion. However, the OSP was significantly more in LTS-II and PLMA (P < 0.001). There were no clinically important complications in the postoperative period. Conclusions: Pediatric size 2 LTS-II is easy to insert and provides higher OSP compared with same size PLMA in anesthetized and paralyzed children undergoing elective surgery. It is a safe alternative to PLMA in short duration elective surgeries and may be a better device as it provides for higher OSPs.

Every year, 80,000–100,000 ablation procedures take place in the United States and approximately 1% of these involve paediatric patients. As the paediatric population undergoing catheter ablation to treat dysrhythmia is constantly growing, involvement of anaesthesiologists in the cardiac electrophysiology laboratory is simultaneously increasing. Compared with the adult population, paediatric patients need deeper sedation or general anaesthesia (GA) to guarantee motionlessness and preserve comfort. As a result, the anaesthesiologist working in this setting should keep in mind heart physiopathology as well as possible interactions between anaesthetic drugs and arrhythmia. In fact, drug-induced suppression of accessory pathways (APs) conduction capacity is a major concern for completing a successful electrophysiology study (EPS). Nevertheless, the literature on this topic is scarce and the optimal type of anaesthesia in EPS and ablation procedures in children is still controversial. Thus, the main goal of the present review is to collect the literature published so far on the effects on cardiac conduction tissue of the drugs commonly employed for sedation/GA in the cath lab for EPS and ablation procedures to treat supraventricular tachycardia in patients aged <18 years. •Anaesthetics can influence procedural outcomes by potentially affecting arrhythmia inducibility.•Tailoring the anaesthetic plan to each patient is crucial to achieving successful arrhythmia ablation.•Children exhibit unique characteristics that cannot be directly extrapolated from the adult population.•While general anaesthesia is largely adopted in elethrophisiology procedures it may affect procedural outcomes.•Future studies should compare general anaesthesia vs. sedation in terms of successful arrhythmia ablation and safety.

Introduction: Stickler syndromes are multisystem connective tissue disorders characterised by a range of ocular and systemic features, including an increased risk of early-onset glaucoma. This report describes two paediatric patients initially assessed before the age of one who were ultimately diagnosed with both Stickler syndrome and infantile-onset glaucoma. Despite different genotypes, both shared similar phenotypes, most notably a strikingly unilateral glaucoma presentation. Case Presentations: Both patients presented with unilateral ocular hypertension and buphthalmus, followed by surgery for craniofacial abnormalities. Multiple surgical interventions were required to achieve intraocular pressure control and both developed comorbidities including hearing loss and cataract. These cases underscore the complex interplay between systemic features of Stickler syndrome and the challenges of managing paediatric glaucoma, particularly in advanced cases with ocular enlargement. Conclusion: The cases highlight the considerable burden placed on families and healthcare systems due to the frequent need for surgeries, examinations under anaesthesia, and prolonged follow-up. Clinicians should consider Stickler syndrome in the differential diagnosis of early-onset glaucoma, even in the absence of overt systemic signs. Early recognition may offer a crucial opportunity to optimise visual outcomes and provide appropriate support for affected children and their caregivers. Families should also be counselled regarding the risk and early signs of glaucoma.

Why was the study undertaken? Why Despite the introduction of the Aiming High in Eczema/Atopic Dermatitis (AHEAD) approach, to our knowledge, no previous investigation of AD symptoms selected by patients and their caregivers based on the said approach has been undertaken. What does this study add? The study highlights the need for taking into account patients' and their caregivers' input in treatment for AD. What are the implications of this study for disease understanding and/or clinical care? With the paradigm shift in AD treatment, various burdens of the disease are receiving attention, and greater application of the AHEAD approach will facilitate shared decision‐making between patients and their caregivers and physicians, with a focus on patient‐reported outcomes, for true disease remission.

Background The adult versions EQ-5D-3L and EQ-5D-5L have been extensive compared. This is not the case for the EQ-5D youth versions. The study aim was to compare the measurement properties and responsiveness of EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric patients. Methods A sample of patients 8–16 years old with different diseases and a wide range of disease severity was asked to complete EQ-5D-Y-3L, EQ-5D-Y-5L, PedsQL Generic Core Scale, and selected, appropriate disease-specific instruments, three times. EQ-5D-Y-3L and EQ-5D-Y-5L were compared in terms of: feasibility, (re-)distribution properties, discriminatory power, convergent validity, test–retest reliability, and responsiveness. Results 286 participating patients suffered from one of the following diseases: major beta-thalassemia, haemophilia, acute lymphoblastic leukaemia, acute illness. Missing responses were comparable between versions of the EQ-5D-Y, suggesting comparable feasibility. The number of patients in the best health state (level profile 11111) was equal in both EQ-5D-Y versions. The projection of EQ-5D-Y-3L scores onto EQ-5D-Y-5L for all dimensions showed that the two additional levels in EQ-5D-Y-5L slightly improved the accuracy of patients in reporting their problems, especially if severe. Convergent validity with PedsQL and disease-specific measures showed that the two EQ-5D-Y versions performed about equally. Test–retest reliability (EQ-5D-Y-3L 0.78 vs EQ-5D-Y-5L 0.84), and sensitivity for detecting health changes, were both better in EQ-5D-Y-5L. Conclusions Extending the number of levels did not give clear superiority to EQ-5D-Y-5L over EQ-5D-Y-3L based on the criteria assessed in this study. However, increasing the number of levels benefitted EQ-5D-Y performance in the measurement of moderate to severe problems and especially in longitudinal study designs.