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The imaging studies shown are from 2 children with cancer who underwent placement of 9.6 French left subclavian central venous catheters (CVCs) to facilitate treatment. Fracture of the catheters with subsequent embolization of the distal fragment to the pulmonary arteries was noted at about 18 months after placement. Findings suggestive of impending fracture were missed in previous radiographs. In both cases, an interventional radiologist removed the fragment via percutaneous catheterization of the right femoral vein.

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This palpable, nontender, nonblanching rash had developed on the elbows of an 18-year-old boy and spread to the ankles and feet. The rash was accompanied by moderate abdominal pain associated with episodes of nonbloody emesis that did not change with eating or bowel movements. Diffuse joint pain developed the day after the rash appeared.

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A 3-month-old infant presented with a 4-week history of a symmetric skin eruption on her face, axillae, distal extremities, and external genitalia. The infant was otherwise healthy, although colicky since birth. She was exclusively breast-fed and had a good appetite. Voiding and stooling patterns were normal. Her growth was appropriate for age.

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In Part 2 of this podcast series, Dr Smith continues his discussion of the practice of nonsuicidal self-injury in adolescents.

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A 4-year-old boy was referred for evaluation of refractory eczema that first appeared at 1 month of age.

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A female infant born at 29 weeks' gestation after premature membrane rupture was admitted to the neonatal ICU in respiratory distress.

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A 4-year-old boy presented for further evaluation of persistent right hip painof 2 months’ duration. Before the onset of the pain, he had been limping,favoring his right side. For several days before he was brought in forevaluation, he had had fevers and sweating in addition to the right hippain.

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In this age of evidence-based medicine and randomized clinical trials, it is easy to forget that careful clinical observation and documentation are the foundation of medical practice.

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The mother of this 11-month-old girl was concerned that her infant’s vagina was almost obscured by a membrane. This was noted incidentally a few days earlier.

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For several days, a 9-year-boy has had painful swelling on the top and left side of his forehead, bilateral eye swelling, intermittent fever, and nasal congestion. He was seen in the office 4 weeks earlier, after he had hit his left eye on a school desk. At that time, he presented with a left retro-orbital headache, nasal congestion and discharge, and intermittent fever.

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The mother of an 8-year-old boy sought medical care for her son, who had complained of a sore throat for 3 days. No fever, drooling, rash, rhinorrhea, cough, congestion, ear pain, neck stiffness, or dyspnea was reported. The boy had not been in contact with any ill persons, although his complaints coincided with a local outbreak of streptococcal pharyngitis.

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This erythematous, blanching papular rash developed on the trunk of a 20-month-old boy 3 days after he became ill with a low-grade fever (temperature of 38.3ºC [101ºF]) and mild upper respiratory tract infection symptoms.

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Ten-month-old girl with swelling of the left knee of 7 weeks' duration. Unable to bear weight on the left leg for the past 2 weeks. No fever or history of trauma to the area. Infant has good appetite for breast milk and formula, but possible malaise.

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A 15-month-old girl presents for evaluation of macrocephaly and unusual facial features. Her prenatal and natal history are unremarkable. The child is now developing normally after mild gross motor delays during the first 6 months of life. Mild scoliosis was noted on a babygram taken at 8 months during an evaluation for possible nonaccidental trauma.

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For 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.

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A 5-year-old boy with seizure disorder and developmental delay presented to our allergy and immunology clinic for a severe reaction that developed after he had received multiple vaccines. One month before our evaluation, the patient had been vaccinated against varicella, hepatitis A, and influenza at his pediatrician's office. Latex gloves were not used for vaccine administration.

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A 45-day-old boy was referred for evaluation of persistent hyponatremia and hyperkalemia. On the 9th day of the boy's life, his serum potassium level was elevated (8 mEq/L) and on the 12th day, his serum sodium level was low (131 mEq/L). Supplementation with sodium chloride was initiated.

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A 10-week-old white baby girl with a history of difficulty in breathing presented with stridor, tachypnea, wheezing, and increased work of breathing.

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The most common chronic medical problem that we pediatricians treat is asthma. We do our best to manage our patients' asthma by prescribing controller medications, providing asthma action plans, and guiding families through acute exacerbations. We often ask about possible environmental triggers, such as tobacco smoke and cockroaches, and we advise patients to reduce their exposure to those triggers.

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Type 2 diabetes, once considered a disease of “adult onset,” is highly resistant to treatment in overweight American youth-a group succumbing to the disorder at an alarming rate.

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A 4-week-old boy with tactile fever for the past 24 hours and fussiness of 2 weeks' duration is referred to the emergency department (ED).

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Botulinum toxin type A has a role in managing spasticity and dystonia in pediatric patients. It can improve gait and upper extremity function when used appropriately.

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A 12-year-old otherwise healthy boy was referred to a sports medicine clinic for back pain of 7 months' duration. The pain, which originated to the right of his thoracic spine, was associated with shooting hockey pucks. Results of his physical examination were normal.

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An African American baby girl was noted to have noisy breathing at birth. The infant had inspiratory stridor while awake and no audible stridor while asleep. Birth weight was 3.20 kg (7.11 lb). She had been formula fed for the first 2 weeks of life and had intermittently vomited after feedings.

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A male neonate was born at 39 weeks' gestation by vertex vaginal delivery with focal swelling of the head. Vacuum extraction and forceps were not necessary for delivery. The mother had no complications during labor. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. A cephalhematoma was suspected when the fluctuant parietal swelling did not transilluminate.

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A 3-year-old girl was hospitalized because of purulent drainage from a right middle finger wound (Figure 1) and a tender right axillary mass (Figure 2) of 2 days’ duration.

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This 9-month-old infant was brought for evaluation of anteroposterior elongation of the cranium. The infant was born at term via uncomplicated vaginal delivery. His mother had noticed that his head was more elongated and narrower than his sibling's. He had achieved appropriate motor and social milestones for his age. Neither parent had a family history of abnormal head shape. The rest of the examination findings were unremarkable.

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A 10-week-old white baby girl with a history of difficulty in breathing presented with stridor, tachypnea, wheezing, and increased work of breathing.

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Two-month-old boy with divot in the lower back, shown here with the gluteal crease relaxed (A) and spread (B). Infant is a product of an uncomplicated pregnancy and delivery. Nursery stay uneventful. Subsequent feeding and growth normal. Parents report no problems with urination or defecation.