The edition · Paediatrics
Earlier egg worked at population scale, and a brush-on treatment arrests caries without a drill
The AAP's 2026-27 COVID-19 vaccine position, two hepatitis A vaccine platforms compared head to head, and the NICU interventions that actually move parental anxiety.
The edition in brief
The American Academy of Pediatrics recommends the 2026-2027 COVID-19 vaccine for all infants aged 6 through 23 months without contraindications, a single dose for anyone aged 2 through 18 at increased risk of severe disease regardless of prior vaccination, and a single dose on request for others; any age-appropriate vaccine may be used and the most updated version available should be given. A meta-analysis of four randomised cohorts totalling 3,282 children found TZ84-based inactivated hepatitis A vaccines produced higher seroconversion at one month (odds ratio 3.05, 95% CI 1.88 to 4.96) and higher antibody concentrations at seven months than HM175-based vaccine, with comparable adverse events, though the evidence rests on surrogate immunogenicity endpoints and studies concentrated in China. Comparing two Melbourne cohorts recruited identically before and after guidelines moved egg introduction earlier, egg allergy prevalence fell from 9.2% to 7.6% after adjustment for risk factors, and from 34.6% to 21.9% among infants with early eczema — population-level confirmation of what the randomised trials predicted. A meta-analysis of 160 NICU studies covering 16,639 parents found psychotherapy and emotional support most consistently reduced anxiety, stress and depression, with family-centred care and education close behind at far lower cost. The practice-changer is a placebo-controlled trial in 830 children aged 12 to 71 months with severe early childhood caries: 38% silver diamine fluoride arrested 54% of active lesions at six months against 22.5% with placebo, without additional pain.
AAP's COVID-19 vaccine position for 2026-27, in three lines
Know which of the three groups the child in front of you falls into — the not-at-increased-risk group is an offer to be made, not a vaccine to be discouraged.
Two hepatitis A vaccine platforms compared, on antibody rather than disease
Either platform protects; let availability and cost decide, and do not revaccinate on the strength of a titre difference.
Earlier egg introduction shows up in the population, not just the trial
Give the earlier-introduction advice most firmly to the parents most likely to resist it — those whose infant has eczema.
What actually helps parents in the neonatal unit
If your unit can only do one thing, make family-centred care and structured education routine — it is the cheapest intervention with consistent benefit.
Look in the mouth of every toddler you examine
Lift the upper lip on every toddler you examine; early childhood caries is silent, visible, and much easier to alter before it hurts.
Silver diamine fluoride arrests half of active caries lesions, painlessly
In a young child with active cavitated caries and no realistic route to restorative care, silver diamine fluoride arrests about half of lesions without pain — provided the family is warned about the black staining.
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