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Botulinum Toxin Therapy in Children: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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Musculoskeletal Clinics: 16-Year-Old Camper With Tibial PainA 16-year-old boy complains of right lower leg pain that began 2 weeks earlier, after his first week at a summer basketball conditioning camp. Before he left for the camp, he was jogging off and on, averaging a few miles a week. At camp he began running 7 miles a day and doing sprints 3 times a week.
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Juvenile Laryngeal Papillomatosis: An Unexpected Cause of StridorThe patient had been born at term following an uncomplicated pregnancy and labor. Her growth and development were appropriate. Her immunizations were up-to-date. At about 1 year of age, she began to have "wheezing" episodes. Moderate persis- tent asthma was diagnosed, and treatment with fluticasone and inhaled albuterol was initiated.
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Morgagni HerniaA 16-year-old boy with Down syndrome was referred for evaluation of nonspecific symptoms, including difficulty in breathing on standing up from a sitting position, dizziness, frequent abdominal pain, and diarrhea after ingesting fatty foods and milk. He had intermittent asthma exacerbations for which he occasionally used a β-agonist. He had no history of trauma, surgery, or allergies.
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Minocycline HyperpigmentationA 17-year-old girl being treated for mild acne, anxiety, and depression, presented with an ankle “bruise” related to an injury sustained 2 years earlier. Symptoms resolved with treatment, but the hyperpigmentation persisted.
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Frey SyndromeEpisodic right-sided facial flushing was noted in a 2-month-old girl born at full term via forceps-assisted vaginal delivery. The erythema appeared within minutes of latching onto her mother’s breast and resolved within 5 to 10 minutes after breastfeeding. The episodes of flushing had begun a week before the clinic visit; there were no collateral symptoms of anaphylaxis. Because food allergy was suspected, the mother had eliminated all dairy products from her diet.
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Herpetic Lesions Primary Herpetic Stomatitis Herpetic Whitlow Recurrent Herpes in Uncharacteristic LocationsA 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.
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A New Zip in Playground InjuriesWhile playing on the school playground, a 10-year-old boy decided to try a zip line. He grabbed the pulley and slid down the cable. When the pulley came to a stop, he fell off and sustained a right ankle injury.
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Infant With Persistent Fever and FussinessA 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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Cystic Hygroma in a 1-Year-Old GirlThe parents of this 1-year-old girl brought her for evaluation of a neck mass of sudden onset (A). They had first noticed the mass on the morning of presentation. The child had cold symptoms and had been snoring, but she had no history of fever, shortness of breath, wheezing, or stridor. Her activity level and appetite had not changed.
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Photoclinic: Foreign-Body IngestionA 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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Drug Eruptions: The Benign-and the Life-Threatening“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.
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The Uncontrollable Child: Family and Educational InterventionsIt is estimated that about 20% of children and adolescents meet criteria for a mental health disorder, and a high percentage of these youths are impaired by disruptive behavior problems.
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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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Acute UrticariaCircumscribed erythematous lesions developed on the back and abdomen of this 19-month-old boy. The rash was mildly pruritic. The parents gave the child 1 dose of diphenhydramine, and the rash resolved after an hour. About 12 hours later, new lesions developed on the face, neck, and upper back. The child was given the same treatment and the symptoms resolved. The following morning, widespread lesions were noted on the child's face, neck, trunk, and extremities.
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Case in Point: Bladder KnotsThe patient was a 6-year-old boy who had Menkes syndrome and bladder diverticula. He was receiving care at home with sterile intermittent catheterization.
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Podcast: How Safe is Vaccination? Answers For Worried ParentsHere, in the second in a series of podcasts, Dr Ellen Clayton reviews findings of a landmark Institute of Medicine study on vaccine safety and offers information about specific vaccines that may be very useful to you when you answer questions from worried parents.
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Boy With Thick Plaques on His Palms and SolesAt his first well-child visit after a family move, an 8-year-old boy was noted to have bilateral erythematous plaques on the surfaces of his hands and feet. Mother reported that the condition had been present since he was 2 or 3 months old. Patient’s father and other male relatives on the paternal side (uncles, grandfather, great-grandfather) were similarly affected. No other associated symptoms, such as hyperhidrosis, reported. The child did not have a history of eczema, asthma, or food allergies; however, he did have a history of allergic rhinitis and occasional pruritus.
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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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Photoclinic: Cutaneous Calcinosis in a Child With Tertiary HyperparathyroidismPhotoclinic: Cutaneous Calcinosis in a Child With Tertiary Hyperparathyroidism
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Genetic Disorders: 4-Day-Old Boy With Multiple AbnormalitiesA 4-day-old boy was transferred to our institution for evaluation of multiple anomalies. He was born to a gravida 2 para 1 mother at 38 weeks of gestation. He weighed 3288 g at birth. Antenatal ultrasonograms at 5, 6, and 7 months had revealed short bones in the legs. The mother was subsequently lost to follow-up--until now.
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Photoclinic: Adverse Reaction to MMR ImmunizationThis 12-month-old girl presented with a diffuse rash that was first noticed by the child's day-care provider a day earlier. A fever (temperature of 39.4°C [103°F]) subsequently developed.
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Pityriasis Lichenoides Et Varioliformis Acuta in a 7-Year-Old BoyA 7-year-old boy was brought for evaluation of a nonpruritic, nonpainful, evolving polymorphic rash that began on the torso and spread to the extremities, face, palms, and soles over a 2-week period. He had been otherwise healthy and had no history of constitutional symptoms.
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A Brain Tumor Presenting as Chronic Intermittent StridorA 2-year-old previously healthy girl was brought to her pediatrician with the chief complaint of persistent noisy breathing. Two months earlier, the child had an upper respiratory tract infection (URI) with rhinorrhea, cough, noisy breathing, and wheezing. All symptoms had resolved except the abnormal breathing. Physical examination findings were unremarkable. A lateral neck x-ray film demonstrated subglottic narrowing, thought to be consistent with croup. Laryngoscopic examination by an otolaryngologist did not reveal any pathology.
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Dyskeratosis Congenita: An Inherited Bone Marrow Failure SyndromeAbnormal pigmentation, nail dystrophy, and leukoplakia may signal dyskeratosis congenita.
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Case in Point: Insights on a "Global" IssueAs an avid reader of Consultant for Pediatricians, I would like to comment on a recently published case involving an 8-year-old boy with an erythematous left eyelid ("Photo Quiz," January 2005, page 24).
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Radiology Quiz1. A 4-year-old girl was brought to the emergency department by her parents on a Sunday afternoon. Because of a clinical history of right upper quadrant pain and trace hematuria, abdominal radiographs were obtained. What do they show?
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Complications of ChickenpoxAfter several days of suffering fever, headache, and malaise, a 17-year-old boy noticed a rash developing over much of his body. He sought medical attention and was admitted to the hospital.
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Molluscum Contagiosum on the Face of a 4-Year-Old BoyDespite curettage several months earlier, the facial rash on this 4-year-old boy had spread across both cheeks and was now mildly pruritic.
