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Infant With Persistent Fever and Cough, Worsening RashA 14-month-old girl presented with persistent fever, cough, and worsening rash of 5 days’ duration. On the first day of the illness, the infant was brought to an acute care clinic for evaluation.
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Case in Point: Thyroglossal Duct CystA 9-year-old Hispanic boy presented with submental swelling and dysphagia. The swelling had progressed over 5 days. He had no history of fever, difficulty in breathing, or voice change.
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Consultations & Comments: A "New" Twist on the Technique of Umbilical Catheterization?We heard from several readers about a Photo Essay we recently published in our February issue entitled "The Butterfly Technique: A New Method of Inserting an Umbilical Vessel Catheter."1 The authors, Lisa A. Wood, MD, and Mark J. Polak, MD, described modifications of standard catheter insertion techniques that facilitated successful line placement.
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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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Infant With Multiple Hepatic MassesA 2-month-old girl who lost 30 g over 7 days is noted to have multiple hepatic masses during abdominal ultrasonography to rule out pyloric stenosis; she is referred for further evaluation. She has a history of physiological jaundice and gastroesophageal reflux (GER). She continues to vomit despite treatment with ranitidine.
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Pediatric Chest Pain: Keys to the DiagnosisChest pain in children evokes anxiety in patients and their parents--and prompts frequent visits to the pediatrician's office, urgent care facility, or emergency department (ED). In a prospective study, Selbst and colleagues reported that chest pain accounted for 6 in 1000 visits to an urban pediatric ED.
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Risky Business, Part 2: Communicating Medical Risks to Patients and ParentsPracticing pediatricians commonlytalk with patients and parentsabout medical risks. Examples of suchrisks include those of a newborn havinga genetic disease, of a complication of anillness developing, and of a patient experiencingan adverse effect from a medicationor vaccine. Different ways of expressingand communicating risk mayhelp patients and parents understand themagnitude of a risk and make informed,thoughtful decisions about their medicalcare. It is important to be aware of theinfluence personal experience and concernshave on how risk is perceived andto recognize how the choice of a particularway of framing a risk may inadvertentlycommunicate a clinician's personalbiases in a situation.
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Fatal Case of Juvenile HemochromatosisA 16-year-old girl presented to the emergency department (ED) with an anaphylactic reaction to a bee sting on the right side of her neck. Within 15 minutes of her arrival, swelling, numbness, and pain developed at this site. She also had headache, shortness of breath, and vague abdominal pain associated with nausea.
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Acute Hemorrhagic Edema of Infancy in an 11-Month-Old GirlFor 2 days, an 11-month-old girl had a progressively worsening rash and subjective fever (A). The rash began on the legs as bumps, which later became large violaceous lesions (B) and spread to the face, arms, and trunk.
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Abdominal Mass in Teenage Girl: Hair's the DiagnosisA 14-year-old girl had fatigue, a slight sore throat, and low-grade fever for a week. The mother was concerned that she had “mono” like her older sister who had the same symptoms and in whom the illness was diagnosed 2 months earlier.
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Hot Tub Folliculitis in an 11-Year-Old BoyAn 11-year-old boy presented for evaluation of an itchy rash that developed during a ski vacation.
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Winter 1979This happened over 25 years ago, but she remembers it clearly. . . . at the time, she was a pregnant intern on the infant-toddler ward of the busiest children's hospital in the Midwest. It was December, and the ward was jumping. One of her patients, Tony, a 3-month-old with tracheomalacia and severe croup was sick and not improving much. Tony's mother was worried mainly about her son, but there were other things. She had recently come north after being laid off in Alabama. Her unemployment had quickly led to homelessness. She had a brother in town, and she had moved in with him. When she arrived, she found out that he was a heroin addict. He was uninterested in her and her son, and his house was unsafe.
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Home Alone: At What Age Are Children Ready?I’d like to increase my hours at my job from part-time to full-time when my son starts middle school. He’d be home by himself for an hour and a half between the end of his afterschool program and the time I’d be back from work. Do you think he’s old enough to be home alone for that time?
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White Patches on a Young Boy's TrunkA 3-year-old boy with white patches on the trunk first noticed shortly after birth.
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That’s Not My Child: A Case of Capgras SyndromeMary, aged 40 years, was referred for psychiatric evaluation out of concern that a mental health diagnosis was interfering with her ability to appropriately and safely care for her child. The patient had stated on numerous occasions that her 9-year-old daughter, had been placed in the custody of Child Protective Services and replaced by an imposter.
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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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Flank Pain, Decreased Urine Output in Young BoyA 10-year-old boy presents to your office with sharp right-sided flank pain. The pain began the night before, and the child could produce only a few drops of urine the next morning.
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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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Neuroblastoma in a Child With Persistent Hip PainA 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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Influenza Vaccine for Egg-Allergic Patients-Safe?My 18-month-old son has had a diaper rash, with no other symptoms, within a few days of eating a poached egg on 3 separate occasions.
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What Caused This Breast Lump?A 16-year-old girl has had a left breast lump for 6 months that recently became tender. Except for several small nodules in both breasts and tenderness of the lateral left breast, physical findings are normal and the patient is otherwise healthy.
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Fish Tapeworm InfestationA 15-year-old boy presented with a “string” protruding about 5 cm from his anus. He had had abdominal cramping that morning, prompting a bowel movement. After the stool, he passed a meter-long object that broke into the toilet. He attempted to remove the remaining “string,” but pulling on it induced left lower quadrant abdominal pain. He denied purposefully ingesting nonfood objects, choking, or chewing anything unusual. He also denied inserting anything or having anything inserted into his anus. He was otherwise healthy and had no significant medical or family history.
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PompholyxFor 3 days, a 10-year-old boy had an itchy, tense, vesicular rash on the fingers of both hands (A). He was otherwise healthy.
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Baby Boy Cries With One Eye OpenThis 1-week-old baby boy was brought for his first newborn visit. The parents were concerned that when he cried, the left side of his face “does not move.”
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Persistent Ankle Mass in an Otherwise Healthy 9-Year-Old GirlAn apparently healthy 9-year-old girl noted to have left ankle mass during well-child checkup. Her last well-child visit was 3 years earlier. Medical history unremarkable. She denied fevers, weight loss, night sweats, and chills. No family history of bone deformities or growth disturbances.
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ADHD and the Adolescent Driver:ABSTRACT: Adolescent drivers with attention deficit hyperactivity disorder (ADHD) are more likely to be involved in--and to die of--a driving accident than any other cause. The higher occurrence of driving mishaps is not surprising given that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity. Safe driving habits can diminish the risk, however. The first step is to inform patients of the dangers of driving; the significance of adolescence, ADHD, and medication can be underscored in a written "agreement." Strategies to promote safer driving--especially optimally dosed long-acting stimulant medication taken 7 days a week--may be critical. A number of measures lead to safer driving by reducing potential distractions during driving (eg, setting the car radio before driving, no drinking or eating or cell phone use while driving, no teenage passengers in the car for the first 6 months of driving, and restricted night driving).
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Fractures From Short Falls: Implications in Children Under Age 5Primary care and emergency physicians frequently see young children who have fractured a bone after a fall from a low height. The child's caregiver may describe a fall from furniture, play equipment, stairs, and various other structures--or the child may have even been dropped while being carried. The clinician then has to decide whether the explanation for the fall is plausible--or whether a child abuse investigation should be pursued.
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Allergic Reaction to Nickel in Swallowed CoinsAn 8-year-old boy seen at a gastroenterology clinic after "accidentally" swallowing 2 coins 4 days earlier. Had difficulty in breathing shortly after swallowing the coins and was taken to emergency department. X-ray films at that time demonstrated coins in his esophagus. Patient was immediately transferred to a tertiary care facility. Repeated x-rays showed the coins in his stomach. Patient was sent home with instructions to follow up with his pediatrician in 1 to 2 days.
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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 Guide to Monitoring and AchievingAsthma Control in ChildrenYounger Than 5 YearsAsthma is the most prevalent chronic disease in children. In the United States, asthma affects approximately 1.4 million children younger than 5 years and causes frequent activity limitations and hospitalizations.
