The Link - June 2026

Sick International Visitor

As Kansas City is the “Soccer Capital of America,” we are fortunate to host several international teams and welcome their fans from across the world this summer. Aside from hosting the teams and matches themselves, there will be multiple fan events throughout the metro area to celebrate the unity that sport provides.

As we welcome international travelers to our city, we must also be prepared to care for them should they become ill. We are familiar with how to evaluate fever in a returned traveler, and this same strategy can be repurposed to evaluate the sick international visitor.

Anesthesia and sedation have become extraordinarily safe for children. Approximately 6 million children undergo anesthesia yearly for a variety of surgical and diagnostic procedures, with 25% of those being infants. For the past decade, the issue of anesthesia-related neurotoxicity has been in the media spotlight ever since a 2016 Food and Drug Administration warning that “repeated or lengthy use of general anesthesia and sedation drugs during surgeries or procedures in children younger than three years of age...may affect the development of children’s brains.” This warning was based on many in vitro and animal studies, while retrospective cohort human studies at the time resulted in less conclusive evidence. In 2010, the Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots (SmartTots) initiative was formed to facilitate research into this important question as well as provide educational tools for patients and medical professionals.

While some babies arrive in the world seemingly content with almost anything, others protest diaper changes, cling tightly to caregivers or react intensely to minor frustrations. These differences often emerge within the first months of life and reflect one of the most important, yet underappreciated, concepts in child development – temperament.

Temperament refers to the biologically based differences in emotional reactivity, activity level, attention and self-regulation that emerge early in life and remain moderately stable over time. When discussing temperament with families, I often describe it as the genetic component of our personality. These early traits serve as the foundation for adult personality and influence mental health throughout the lifespan.

An 8-year-old boy with a history of atopic dermatitis presents for evaluation of hair loss. His parents first noticed a small bald patch on the back of his scalp approximately two months ago. Since then, a second patch has appeared on the left side of his scalp. The areas are asymptomatic, and he denies pain, itching or increased hair shedding. There has been no recent illness, fever, hospitalization, weight loss or medication changes.

On examination, there are two well-circumscribed patches of hair loss on the right and left occipital scalp. The underlying skin appears smooth without scale, erythema or scarring. The follicular ostia are present. Several short hairs tapering toward the scalp are noted at the margins of the patches. There is no cervical or occipital lymphadenopathy. There is regular pitting of the nails. The eyebrows and eyelashes are normal.

WISE use of antibiotics in pertussis: when they help—and when they don’t. Balancing antibiotic stewardship with controlling public health outbreaks.

Children tend to cough for various reasons, including normal viral patterns in infancy and toddlerhood, bronchiolitis, pneumonia, asthma, gastroesophageal reflux, allergies, and habit coughs, to name a few. Amid surging pertussis cases, likely driven by waning vaccine immunity and increased vaccine hesitancy, it is important to know when to have pertussis on your differential, when to test, and when to treat.