The Link - August 2026

Kawasaki disease (KD) is an acute vasculitis, primarily affecting the coronary arteries, and remains the leading cause of acquired heart disease in children in developed countries. In the United States, the incidence of KD is approximately 18-25 cases per 100,000 children <5 years old. The exact etiology of KD remains unknown but is thought to be the result of abnormal immune responses to an infectious and/or environmental trigger. Early recognition and treatment are especially important because 25% of untreated children develop coronary artery dilation or aneurysms. Prompt recognition and treatment with intravenous immunoglobulin (IVIG) reduce this risk to <5%.

Attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children presents a distinct diagnostic and therapeutic challenge for clinicians. Although ADHD symptoms may be evident by age 4, management in this age group requires careful attention to developmental context, impairment, comorbidity and treatment tolerability. The decision to treat preschool ADHD is driven by functional impact rather than symptom presence alone. Because ADHD frequently co-occurs with anxiety, oppositional behaviors, language delay, sleep disturbance, and other developmental or behavioral concerns, the initial evaluation should include a broad differential diagnosis and a focused search for comorbidities.

Vaccine conversations have become increasingly complex in today’s information environment. Families are often exposed to conflicting messages about vaccines and may struggle to determine what information is accurate and who they can trust. Research consistently shows that trust in a health care clinician is one of the strongest factors influencing vaccine decisions. Health care professionals are frequently identified as caregivers’ most trusted source of vaccine information.

When clinicians ask how they can best educate families about vaccines, the answer often begins with relationship-building. People are more likely to consider and accept health recommendations when they trust the individual delivering the message. Establishing a respectful, ongoing relationship creates opportunities for meaningful conversations, even when caregivers are initially hesitant.

A 13-year-old girl with Fitzpatrick type V skin and a lifelong history of a poorly controlled itchy rash presents for her first dermatology visit. Her mother reports persistent itching that worsens at night and interferes with sleep and school performance. She has been treated intermittently with over-the-counter moisturizers and mid, low and high-potency topical corticosteroids.

On examination, there are well-defined, thickened (lichenified), dark brown, slightly erythematous plaques on both wrists, the inner elbows and behind both knees. On closer inspection, the palms have exaggerated, deepened skin lines, and polygonal scales are present on both shins. There are no vesicles, pustules, honey-colored crusting, burrows or dome-shaped papules.

Summer often brings opportunities to cool off in pools, lakes, rivers, oceans and water parks—activities enjoyed by children of all ages. However, recreational water exposure can also increase the risk of illness. Viruses, bacteria and parasites may be present in all types of water, including water treated with chlorine. Infection can occur through ingestion of contaminated water, inhalation of aerosols or direct contact with contaminated water.

An estimated 7.15 million waterborne illnesses occur annually in the United States. Among the most common are otitis externa, norovirus infection, giardiasis, cryptosporidiosis and campylobacteriosis. Children are disproportionately affected because they spend more time in the water and are more likely to swallow contaminated water. Understanding the presentations of recreational water illnesses can help clinicians recognize these infections, determine when diagnostic testing is warranted, and guide appropriate treatment.