The Link - October 2026

After peaking in the early 2010s, opioid prescribing declined due to increased government oversight and guidelines created because of the opioid-related overdose crisis.Many clinicians hesitate to prescribe opioid medications because of concerns about adverse effects, tolerance, misuse and the potential for overdose. However, when used appropriately and as part of a multimodal pain regimen, opioids can play an important role in the treatment of acute pain, and in some cases, chronic pain in pediatric patients. Failure to adequately treat pain can have significant short- and long-term consequences. Undertreated pain can contribute to decreased mobility, impaired participation in daily activities, sleep disturbances, emotional distress such as anxiety and depression, and delayed recovery. Persistent, poorly controlled pain may lead to central sensitization, a process in which the changes within the nervous system result in heightened pain perception and increased sensitivity to future pain stimuli. This article aims to summarize the most clinically relevant recommendations from the 2024 American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG) on opioid prescribing for acute pain in the outpatient setting.

There are a couple of viruses (besides measles) that have been in the news lately: enterovirus-D68 and dengue virus. 

Enterovirus-D68 (EV-D68): A Respiratory Virus on the Rise

On Sept. 11, 2026, the Kansas Department of Health and Environment (KDHE) released a Health Alert describing a rise in pediatric emergency department visits for children with acute respiratory illnesses coupled with wheezing.1 The alert highlighted an increase in wastewater detection of EV-D68. Enteroviruses are a huge genus of viruses causing a variety of illnesses, including infections caused by poliovirus and coxsackie viruses. EV-D68 is one of the serotypes of enteroviruses.

Case Presentation

A 13-month-old boy presents for evaluation of a slowly enlarging lesion on the upper back. His parents first noticed a small red spot at approximately 5 months of age that they initially thought was a mosquito bite. 

Rather than resolving, the lesion gradually enlarged and developed intermittent episodes of increased redness and occasional blistering. During these episodes, the lesion also appears to spread slightly before returning to its original size and light brown color.

The lesion does not appear painful or pruritic, and no clear trigger has been identified. There are no similar lesions elsewhere on his body. His parents deny episodes of flushing, shortness of breath, vomiting, diarrhea or fainting.

As the weather gets colder and the days get shorter, it is time to start thinking about influenza. Activity usually increases in October or November, but surveillance suggests an earlier start this year, with West Coast cases reported in August and September.

Influenza can cause substantial morbidity and mortality in children. The 2024–2025 season included 297 reported pediatric deaths, the most since reporting began in 2004. Complications can include anything from acute otitis media and bacterial pneumonia to myocarditis and influenza-associated encephalopathy. While antivirals may shorten symptoms and reduce complications, pediatric prescribing remains inconsistent. In a recent survey, pediatric clinicians recommended oseltamivir in only 36.2% of scenarios, although most met treatment criteria in guidelines. Key barriers were limited guideline awareness, uncertainty about effectiveness and concerns about adverse effects.