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Hypersensitivity to Vaccine StabilizerA 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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Oral Health:The American Academy of Pediatricians (AAP) holds that pediatricians are responsible for oral health supervision of children younger than 3 years. How can I do a credible job of this in a busy office practice?
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Wheeze in Preschool Children:Severe disability and even death can result from the inappropriate diagnosis and treatment of a young child's wheezing, which is heterogeneous in its origins and expression. Consequently, a differential diagnosis is necessary to determine the cause and to develop an effective management strategy. Viral-induced wheeze, especially from respiratory syncytial virus (RSV), manifests as a bronchiolitis. Recent reports show that the cysteinyl leukotrienes are an important mediator of the airway effects of RSV infection and that leukotriene receptor antagonists reduce postrespiratory syncytial virus lung symptoms. Exercise-induced bronchoconstriction manifests as wheezing and can be treated or pretreated short-term with inhaled bronchodilators or cromolyn: long-term therapy includes inhaled corticosteroids and leukotriene receptor antagonists. Allergic rhinitis-associated wheeze may be the result of acute exposure to an allergen or simply from nasal dysfunction. Control of allergic rhinitis with intranasal steroids, antihistamines, or leukotriene receptor antagonists could relieve the wheezing. Asthma-associated wheeze requires long-term use of 1 or more daily controller medications. The primary goal is to navigate the child safely through the first episode of wheezing, consider the causes of the wheeze, and then evaluate the need for further therapy. All apparent causes of wheeze should be treated with the idea that if the apparent cause turns out not to be the actual cause, treatment can be safely discontinued.
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To Their Good Health: Key Points About College Health Care for High School GradsYou sign his required college forms and give him his meningitis vaccine. As you prepare to say "good luck," you wonder what counsel you can offer to help him become a healthy and educated medical consumer and patient.
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Secondary Syphilis Palmar LesionsThe patient denied use of new skin products, detergents, or medications. He had no pets. There was no history of recent travel, and the patient was not aware of any arthropod bites. None of his family members had a similar rash. The patient was sexually active and had had 3 partners in the past 2 years; he said he always used condoms. His history was otherwise unremarkable, as were physical findings.
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Case In Point: Perilymphatic FistulaA 4-year-old girl was brought to a local emergency department (ED) after an episode of dizziness, vomiting, and horizontal nystagmus.
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Polycystic Ovary Syndrome: Update on the Pros and Cons of Treatment OptionsABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among females of reproductive age. In adolescents, PCOS often manifests with irregular menses, hirsutism, and acne. Despite general agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents. Treatment is focused on weight loss, menstrual cycle regulation, and amelioration of physical symptoms. Acute symptoms can be managed with combination oral contraceptives and antiandrogens and potentially with insulin-sensitizing drugs. Lifestyle modification, especially in overweight patients, can reduce symptoms and help prevent long-term health consequences.
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Infant With Recurrent Omphalitis and OtitisA baby boy, aged 14 days, presented with a temperature of 38.2°C (100.8°F), a generalized maculopapular rash, and purulent otorrhea. He was treated with oral amoxicillin for 10 days. At age 25 days, he again presented-this time with erythema and edema of the umbilicus, thrush, and fever of 24 hours’ duration.
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Case In Point: Clavicle Fractures in ChildrenClavicle fractures in the pediatric population are very common. Clavicle fractures in the pediatric population are very common. Clinical manifestations include decreased movement of the arm on the affected side, crepitus, and/or bony irregularity at the fracture site. Here, a review of fracture in newborns and older children.
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May-Thurner SyndromeA 14-year-old girl with systemic lupus erythematosus (SLE) was evaluated for worsening left leg pain of 1 week’s duration. A month earlier, she had presented with left knee arthritis and a vasculitic rash; the antinuclear antibody titer was positive. In addition, she had leukopenia, myositis, hypocomplementemia, and mild proteinuria.
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Child With Bullous Lesion on Left Side of GroinA 16-month-old Hispanic girl presented with a 2-day history of pain, redness, and swelling of the left side of her groin. Her mother first noticed the lesion after the child was seen limping and scratching the area. The mother thought her child had been bitten by an insect but did not witness any bite.
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Conflicting Recommendations for Lipid Screening and Management in Children: The Need for ConsensusIn July 2008, the American Academy of Pediatrics (AAP) updated their recommendations on lipid screening and cardiovascular health in childhood.1 The new recommendations created a media stir because of the endorsement of the use of statins in certain at-risk children as young as 8 years.
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Photoclinic: Corneal AbrasionOn waking up from a nap, a 5-month-old infant was noted to have a watery right eye. The mother thought an eyelash was the problem and flushed the eye with water. Soon afterward, the eye watered again and began to close. There was no history of injury, foreign body, upper respiratory tract symptoms, or fever.
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A Toddler Intolerant of Tube FeedingA 22-month-old boy with failure to thrive presented with a 3-day history of rhinorrhea, fever, and abdominal pain associated with tube feeding. A PEG tube had been placed 2 months before this visit.
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Cough and Cold Treatments for Children:Despite the plethora ofover-the-counter cough and cold medicationsdesigned to relieve a variety ofsymptoms of the common cold-primarilynasal congestion, rhinorrhea, and cough-no treatment has been shown to have anybeneficial effect in children, and some maycarry a substantial risk of adverse effects.Even routine symptomatic therapies suchas antipyretics and humidified air maybe counterproductive. Parental educationis the best medicine. Parents need tounderstand the duration and expectedsymptoms of the common cold. Advisethem about specific changes in symptoms(eg, rapid or labored breathing) or duration(eg, a cold lasting 10 days or morewithout improvement) that would warranta re-evaluation by their child's physician.Parents also need to be educated aboutthe lack of proven efficacy and the potentialadverse effects of available cold remedies.Saline nose drops and adequate fluidsas well as antipyretics for bothersomefever may provide limited symptomatic relief,but time is still the only known cure.
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Perianal Finding--Sexual Abuse or Normal Variant?A 23-month-old girl was brought to the pediatrician's office by her mother who was concerned about "bulging down there." The child's mother reported that a "bump" had been present in the girl's diaper area since her birth and that it had been growing.
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Foreign-Body Aspiration: A Guide to Early Detection, Optimal TherapyABSTRACT: Because foreign-body aspiration can cause symptoms that mimic those of other respiratory conditions, a high index of suspicion is crucial in all children who have pneumonia, atelectasis, or wheezing with an atypical course--especially when these conditions are unresponsive to usual medical therapy. A history of choking can usually be elicited in a patient who has aspirated a foreign body: such a history should be sought when respiratory symptoms develop suddenly. However, the absence of a choking history does not rule out foreign-body aspiration. Moreover, patients may be asymptomatic initially. Normal radiographic findings do not exclude an aspirated foreign body. Bronchoscopy should be strongly considered when an aspirated foreign body is suspected, even if radiographic images show normal findings. Rigid bronchoscopy is the procedure of choice for removing aspirated foreign bodies in children. Prevention of foreign-body aspiration can be enhanced through anticipatory guidance of parents/caregivers and through continued product safety efforts.
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Sialoadenitis in a TeenagerFifteen-year-old girl with several- day history of worsening right-sided facial pain and swelling. Pain severity 10 on a scale of 1 to 10. Limited oral intake.
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Photoclinic: Actinomycosis in a Young BoyA 9-year-old Hispanic boy, previously in good health, was admitted for evaluation of chronic right cervical adenopathy. The node had been present for about 6 weeks. The patient was initially taken to his primary medical doctor and given dicloxacillin, but there was no improvement. The patient reported no fever, sore throat, travel history, or animal exposure. He and his parents denied contact with any persons with tuberculosis. During the past year, the patient had undergone extensive dental work for excessive caries.
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Differentiating Epileptic Seizures From Nonepileptic SpellsIt can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Children with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events.
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A Wormian Bone in a NeonateWormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.
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Can You Distinguish Among These Diaper Dermatoses?Match the photographs of the rashes with the correct diagnosis.
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Snippets of Vaccine History: Success, Failure, and ControversyVaccination against infectious diseases has saved millions of lives. The recurrent threat of influenza pandemics and the prevalence of global HIV infections underscore the need for better-designed, more effective vaccines.
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Jacquet's Dermatitis: An Unusual Type of Diaper RashJacquet’s dermatitis a rare, severe variant of irritant diaper dermatitis, presents with punched-out erosions or ulcerations with crater-like borders.
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Neonatal Testicular TorsionOn examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable.
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Hydrocephalus Secondary to GBS MeningitisA female infant born at 29 weeks' gestation after premature membrane rupture was admitted to the neonatal ICU in respiratory distress.
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Warding Off the Common Cold in Young ChildrenDr Pytlak offers tips on what parents can do to protect the whole family from colds and flu this season with some seasoned home remedies.
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Henoch-Schönlein purpura with gastric wall thickeningFor 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
