Within what window after measles exposure is vaccination still useful for post-exposure prophylaxis?
Measles-containing vaccine for post-exposure prophylaxis is useful if given within 72 hours (3 days) after exposure in a susceptible, vaccine-eligible person. After that window, vaccination is not considered effective as PEP, although it should still be given later for routine protection if indicated. If the exposed pe
For an immunocompromised child exposed to measles, when is immunoglobulin preferred over live vaccine?
For an immunocompromised child exposed to measles, immunoglobulin is preferred over a live measles-containing vaccine when the child is moderately to severely immunocompromised, because MMR is contraindicated for most immunocompromised hosts and may be unsafe or ineffective in that setting. In post-exposure prophylaxis
Beyond asthma, which pediatric conditions warrant active secondhand smoke screening at routine visits?
Actively screen for secondhand smoke exposure at all pediatric routine visits, and be especially deliberate when the child has recurrent ear disease, bronchiolitis/recurrent wheeze, chronic cough or frequent respiratory infections, sleep-disordered breathing, prematurity/BPD or other chronic lung disease, congenital he
How should I counsel families who believe outdoor or intermittent vaping is safe for children?
The safest advice is: there is no evidence-based “safe” level of children’s exposure to vape aerosol, and outdoor or intermittent use only reduces exposure—it does not eliminate it. E-cigarette aerosol can contain nicotine, ultrafine particles, and other potentially harmful chemicals, and children may also be exposed t
How do I assess whether poor sleep is worsening an adolescent's coexisting anxiety or depression?
In an adolescent with coexisting anxiety/depression and poor sleep, assess whether sleep is worsening mood by establishing temporal linkage, daytime impairment, and change after sleep improvement/worsening. In adolescents, sleep disturbance is common, often bidirectional with anxiety/depression, and may precede or ampl
How does untreated ADHD complicate management of an adolescent presenting with chronic insufficient sleep?
Untreated ADHD can make an adolescent with chronic insufficient sleep harder to assess and manage because the relationship is bidirectional: ADHD symptoms can worsen sleep timing, sleep initiation, and bedtime adherence, while insufficient sleep further worsens inattention, impulsivity, emotional dysregulation, daytime
When should I step a child with atopic dermatitis up to calcineurin inhibitors or systemic therapy?
In a child with atopic dermatitis, step up from emollients plus topical corticosteroids to a topical calcineurin inhibitor (TCI) when disease is persistent or relapsing despite appropriate topical steroid use and skin care, when you need a steroid-sparing option for sensitive areas such as the face, eyelids, neck, skin
How should I choose and quantify moisturizer to optimize barrier repair in childhood eczema?
Use a bland, fragrance-free leave-on emollient as baseline therapy for all childhood eczema, and prescribe enough that under-dosing does not occur: roughly 250–500 g/week for a child if applying at least twice daily to most or all of the body. Thick ointment or cream vehicles usually repair barrier function better than
How do I distinguish a true recurrent GAS infection from chronic streptococcal carriage in a child?
In a child with repeated positive throat tests for Group A Streptococcus (GAS), true recurrent GAS pharyngitis is more likely when each episode has the classic clinical picture of streptococcal pharyngitis and the child shows clear, prompt improvement within about 24–48 hours of appropriate antibiotics. Chronic strepto
At what recurrence frequency should I refer a child with recurrent tonsillitis for tonsillectomy?
Refer when a child meets the Paradise frequency threshold: ≥7 documented, clinically significant sore-throat/tonsillitis episodes in the past 1 year, or ≥5/year in each of the past 2 years, or ≥3/year in each of the past 3 years. This remains the standard pediatric threshold used to consider tonsillectomy for recurrent
