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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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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Folk Remedy as a Cause of Septicemia in a Child With LeukemiaA 15-year-old Hispanic boy with refractory T-cell acute lymphoid leukemia was hospitalized because of fever and pain and swelling of the right knee of 3 days' duration. The patient was taking nelarabine for a recurrence of his leukemia, which was diagnosed a year earlier. He appeared nontoxic. His temperature was 39.28C (102.68F). Other vital signs were within normal limits. The right knee was warm and tender, with mild restriction of movement.
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Consultations & Comments: Acetaminophen and Asthma: Any Connection?What evidence is there that acetaminophen can cause or exacerbate asthma?
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Childhood Obesity, Part 1: Weight Evaluation and Comorbidity ScreeningMeasurement of body mass index (BMI) is an effective way to screen for obesity and is an important part of the routine health evaluation of all children. A fasting blood sugar test is recommended for obese children 10 years and older who have a BMI above the 85th percentile for their age and sex and 2 high-risk criteria for diabetes (eg, positive family history or signs of insulin resistance). Patients with a BMI at the 85th percentile or higher also require screening for other comorbidities. Such screening includes measurement of waist circumference, blood pressure, lipid levels (specifically, levels of high- and lowdensity lipoprotein cholesterol and triglycerides, as well as total cholesterol), and liver transaminase levels.
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A Young Girl With Unexplained Cervical Lymphadenopathy: Infection? Lymphoma--or Something Else?An 11-year-old African American girl was hospitalized with new fever in the context of unexplained cervical chain lymphadenopathy. WBC and ANC were low, ESR and LDH levels were elevated. Does the image here offer a clue to the ultimate diagnosis?
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Photoclinic: Imperforate Anus With Anocutaneous FistulaDuring their physical examination of this infant who had been born at term via cesarean section, Richard W. Hartmann, Jr, MD, and J. Christiane Salansky, MD, of Halifax Medical Center, Daytona Beach, Fla, found no evidence of an external anal opening (A). A soft bulge was present at the anal site, and the external sphincter was palpable. The median raphe was thick; a drop of meconium was noted on the surface of the perineum midway from the anus to the base of the scrotum (B). The remainder of the examination findings were normal.
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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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Case in Point: Ups and Downs of Trampoline UseA 14-year-old girl came to the office with severe hip pain, which occurred after she attempted a cheerleading maneuver on a trampoline. She reported that she was bouncing as high as she could and landed on the trampoline with her left knee flexed and her right hip extended. On impact, she felt a "pop" that was immediately followed by right hip pain. She could barely move after the landing but managed to get off of the trampoline; she has been walking with pain since her injury.
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Controlling Pediatric Migraine-ContinuedI read with keen interest Dr Jack Gladstein's article, "Pediatric Migraine: Strategies for Maintaining Control," in the August issue of CONSULTANT FOR PEDIATRICIANS (page 316). It prompted several follow-up questions, which I hope the author can respond to.
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Photoclinic: Pathologic Fracture of an Aneurysmal Bone CystRight lower leg pain prompted a 15-year-old boy to seek medical attention. An hour earlier, he had fallen on the leg during a football game and on standing had heard a "pop." No gross abnormality was noted. Jack-Ky Wang, MD, and Laurie Meng, PA-C, of Palos Heights, Ill, report that radiographs revealed a transversing pathologic fracture through an expansile lytic lesion of the right fibula.
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Asymmetric Crying FaciesThis baby boy was born at term to an 18-year-old primigravida via spontaneous vaginal delivery. The membranes ruptured about 6 hours before delivery. The amniotic fluid was heavily stained with meconium. Forceps were not used during the delivery. The newborn initially had poor tone and no spontaneous respirations, but his heart rate exceeded 100 beats per minute. Bulb and deep suctioning as well as supplemental oxygen were provided. Apgar scores were 3 and 8 at 1 and 5 minutes.
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Child With Unusual Appearance, Inguinal Hernia, Accelerated Growth, and Developmental DelayA 10-month old white child was admitted for evaluation of an enlarged abdomen, splenomegaly, and developmental delay. The child had a normal gestation and birth weight. He had a right hydrocele at birth and rapid scrotal enlargement at age 3 months that led to repair of a right inguinal hernia.
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Pityriasis Rosea in a 17-Year-Old Girl17-Year-old female with a salmon-pink oval patch on her back. Three days after the patch appeared, a generalized eruption developed on her back. Eruption slightly pruritic. No antecedent upper respiratory tract infection. No prodromal symptoms.
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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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Focusing on Depression in Expectant and New FathersThis article reviews the limited but growing literature about prenatal and postpartum depression in fathers.
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Case In Point: Erythema Ab IgneA 14-year-old African American boy presented during the winter months with a painless, nonpruritic, periumbilical rash that had been present for approximately 1 month. Initially bluish, the rash had become dark brown.
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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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Aplasia Cutis Congenita in an InfantDevelopmentally healthy 9-month-old boy brought for evaluation of congenital pale pink 2-cm plaque on left parietal scalp. Lesion relatively unchanged since birth. No history of birth trauma or scalp electrode monitoring in the intrapartum period. Mother denied varicella infection during pregnancy.
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Infant With Multiple Birthmarks and Hypertrophic Left ArmThree-month-old boy with multiple birthmarks and hypertrophic left arm. Infant was born at 38 weeks’ gestation to a 33-year-old gravida 2, para 1 after an uncomplicated pregnancy and normal spontaneous vaginal delivery. Birth weight, 3.45 kg; length, 53 cm. Both parents healthy, nonconsanguineous. No family history of growth abnormalities. Father had port-wine stains on nape and chest.
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Unexplained Bruising: Weighing the Pros and Cons of Possible CausesA 3-month-old boy was brought by his mother to his busy primary care physician’s office for follow-up of bronchiolitis when numerous bruises were noted. The mother said that the infant had a 1-week history of unexplained bruising, petechiae, and irritability. The child was referred to the local emergency department (ED) because of concern for nonaccidental trauma.
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5-Month-Old Girl With Left Facial Droop of Sudden OnsetA 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies.
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What Is This Annular Rash?The mother of a 4-year-old boy noticed a rash on her son's left shoulder the day before. The otherwise healthy, asymptomatic boy plays outdoors daily in his hometown of West Virginia. Earlier in the week, he told his mother that he had felt a "scab" on his shoulder and had picked it off.
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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Acute Poisoning: Keys to Zeroing In on the CausePoisons have been a threat to the health and well-being of humankind for millennia. Given the ubiquitous nature of potential poisons, exposure to a toxin should be included in the differential diagnosis of patients with unexplained illnesses or unusual presentations.
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What Are Common Comorbidities in ADHD?In this expert Q&A, Julie Sherman, PhD and Jay Tarnow, MD briefly discuss the latest research findings on ADHD.
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Tularemia in a 4-Year-Old GirlDuring spring vacation, a previously healthy 4-year-old girl visited western Nebraska, where she and her family spent time along a river bank in a wooded area. After 4 days, her mother noticed 3 engorged ticks embedded in the child's scalp. The ticks were immediately removed and burned. The child also had a marble-sized swelling on the right side of her neck. Over the next few days, the child had temperatures that spiked to 39.4C (103F), with chills, generalized malaise, and weakness. There was no history of cough, myalgias, or headache.
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Adenoviral Hepatitis in an Immunocompetent ChildAdenovirus infection is usually benign in healthy children, but it can be complicated by severe or fatal pneumonia, myocarditis, and hepatitis. Consider adenovirus infection in children with fulminant hepatic failure.
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Osteogenesis Imperfecta in a 3-Year-Old BoyA 3-year-old boy who presents with blue sclerae and a history of tibial fracture following a minor trau- ma (jump from a height of less than 18 inches). Has a long-standing complaint of back pain. Mother remarks that the boy bruises easily. Medical history otherwise unremarkable.
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Adolescent Confidentiality: Where Are the Boundaries?The angry mother of a 15-year-old girl has called the office multiple times asking for the laboratoryresults from her daughter’s office visit last week and demanding to know whether the teen was “put on the pill.” Along with other lab work, tests for sexually transmitted infections (STIs) and pregnancy were performed, and the patient was given a prescription for a hormonal contraceptive.
