William A. Gibson, MD

ABSTRACT: Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes and those with early or undifferentiated rash. The morphology of lesions among children with symptoms of serious illness offers clues to the underlying cause. Purpura or ecchymoses in a well-appearing child may not be associated with serious illness; a large percentage of children who present with fever and purpura have Henoch-Schönlein purpura. Kawasaki disease typically manifests with blanching rash and fever. Vesicular or bullous lesions and fever are the hallmark of erythema multiforme, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Umbilicated papules and pustules are the sine qua non of molluscum contagiosum and varicella.

Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes, and those with early or undifferentiated rash.

Children who present withrash and fever can be roughly dividedinto 3 groups: the first group includesthose with features of serious illnesswho require immediate intervention.

ABSTRACT: Children who present withrash and fever can be roughly dividedinto 3 groups: the first group includesthose with features of serious illnesswho require immediate intervention. Thesecond and third groups include thosewith clearly recognizable viral syndromes,and those with early or undifferentiatedrash. Here the focus is on those childrenin group 1 who have petechiae or purpura.The morphology of lesions amongchildren with symptoms of serious illnessoffers clues to the underlying cause.For example, petechiae may herald suchlife-threatening disorders as meningococcemia,Rocky Mountain spotted fever,and hemolytic uremic syndrome.

ABSTRACT: Young children with suspected foreign-body aspirations are common in emergency departments and primary care offices. A "sentinel event" consisting of a sudden onset of choking, gasping, gagging, wheezing, stridor, difficulty in breathing, change in phonation, or difficulty in swallowing may indicate aspiration. In many cases, the diagnosis is missed because the child is asymptomatic on presentation. Normal physical findings can be misleading or the child may have nonspecific symptoms that are initially misdiagnosed as asthma, croup, bronchitis, or pneumonia. Except for endoscopy, most routine diagnostic studies can be falsely reassuring when results are normal. The literature is reviewed here and recommendations are made about how to evaluate and safely manage children with suspected foreign-body aspiration.