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For several weeks, a 6-year-old girl has had a worsening mildly pruritic rash on the trunk. She has a history of seasonal allergies. The family has had a cat and a dog in the house for a number of years.

Primary 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.

This 14-year-old boy has Lesch-Nyhan syndrome. The picture shows chronic scarring of the lip--a result of self-mutilating behavior that characterizes this syndrome. Lesch-Nyhan syndrome is also characterized by dystonia, choreoathetosis, and mental retardation--all of which are associated with hyperuricemia, write Arvind Vasudevan, MD, and Atiya Khan, MD, of Morgantown, WVa. This X-linked recessive abnormality of the long arm of the X chromosome (Xq26) causes a deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) in the brain, liver, and red blood cells.1 In the United States, this condition may be as rare as 1 in 1.2 million.2 Because of the mode of transmission, this disorder affects males primarily; however, cases involving females have been reported.1 Partial variants of the syndrome involving decreased, but not entirely absent, levels of HGPRT also have been identified.2

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.

Photoclinic: Catscratch Disease This 12-year-old girl had a persistent, nontender enlarged lymph node in the right groin. After the lymphadenopathy had failed to respond to antibiotic therapy, pathologic examination of the lymph node established the diagnosis of catscratch disease. The child remembered that she had been scratched on the right calf by a cat the month before; the scratch had already healed when the lymph node appeared. This child had no symptoms other than lymph node enlargement; however, systemic symptoms of fever, malaise, and headache may occur 2 to 3 weeks after a cat scratch. Spontaneous node regression usually occurs within 4 weeks writes Barbara Barlow, MD, of New York, NY.

A 14-year-old boy was brought by Child Welfare Services and the police for a pre-placement examination before entering foster care. The patient had been in foster care for the last 6 months after an allegation of maternal drug use; he had run away from his last foster home. He was found with a 13-year-old friend and his 17-year-old brother--both of whom were also on the run and in foster care.

This 13-year-old boy plays basketball for his school team. His mother brings him to your office and asks you about her son's toenail that has changed appearance and now looks like his father's great toenail. The father has psoriasis.

Giving patients vaccination records for their children can helpboost up-to-date vaccination rates across all racial and ethnicgroups. But giving parents a shot card also increases rates ofover-vaccination in most groups.

Pediatricians are running out of time to influencepay-for-performance measures that are set to transform health-caredelivery. The future is not entirely bleak, said Paul Miles, MD,vice president and director of quality for the American Board ofPediatrics at the PAS Annual Meeting today, but the profession mustact now if pediatricians are to shape the solution and not beshaped by it.

A first-ever survey suggests that erectile dysfunction (ED) is acommon problem in adolescent males. In a Chicago survey of 302 menbetween 18 to 25 years of age, 13% reported ED and 25% reported EDwhile putting on a condom. Among the same group, 6% reported usingsildenafil (Viagra) or some other ED medication, most often inconjunction with recreational drugs.

"Savvy pediatricians are adding lawyers to the health care teamserving low income and disadvantaged children. The lawyers are notthere to protect the practice," said Barry Zuckerman, MD, chief ofPediatrics at the Boston Medical Center, speaking at the PAS AnnualMeeting, "but to improve medical care for children.

Putting children in daycare while one or both parents work is anexpensive proposition. A new study from the Boston area, discussedtoday at the PAS Annual Meeting, suggests that illness associatedwith children in daycare costs the US economy more than $1.5billion annually in direct health services, lost productivity, andother costs.

Pediatricians can expect problems meeting vaccination schedules forhuman papillomavirus (HPV) vaccine. Based on data from the 1996 to2002 Medical Expenditure Panel Survey, only 11% of adolescents haveprimary care visits on a schedule appropriate to HPV vaccination.

Pediatricians have been waiting for solid data on the effect ofwatchful waiting on acute otitis media for two years. That's howlong it has been since the American Academy of Pediatrics and theAmerican Academy of Family Physicians issued new guidelinesoffering observation as a treatment choice for non-severe AOM.

Getting around an unfamiliar city can make even the most seasonedtraveler a little nervous. Take the stress out of your trip andplan ahead with these travel tips.

Welcome to the Spring 2006 Pediatric Academic Societies AnnualMeeting edition of Dateline, delivered to you by the editors ofContemporary Pediatrics!

Getting around an unfamiliar city can make even the most seasonedtraveler a little nervous. Take the stress out of your trip andplan ahead with these travel tips.

From amazing seafood spots to its famous Chinatown, San Franciscois a city known for culinary creations. Visitors are sure to findsomething for their taste buds among these top picks.

The bay city has attractions to appeal to every visitor. Whetheryour interest is history, culture, architecture, or nature, thecity holds a little something for everyone. This relatively smallcity that prides itself on its distinct neighborhoods, greatattractions and entertainment, and creative cuisine, is best seenon foot.

Attendees of the 2006 Pediatric Academic Societies' Annual Meeting,are lucky enough to be surrounded by the beauty of one of the mostindividualistic cities around. San Francisco is not the typicalCalifornia hot spot, with its cool temperatures, a colorful past,and cultural attractions.

You can help working parents manage the day-to-day demands of their lives by providing them with mental health tips for their children. The payoff for doing so can be large: Studies demonstrate a close relationship between mental health and physical health. The list of tips?some as fundamental as urging parents to seek professional help if they sense a problem with their child's psychological well-being or balance?comes courtesy of the National Mental Health Association, as part of Mental Health Awareness Month in May.

Poison control centers receive a call every 15 seconds about an accidental poisoning, and records of the National Safety Council reveal that more than 50% of two million poisoning incidents each year involve children less than 6 years of age. To increase awareness of the danger to children of accidental poisoning from pesticides and household products, National Poison Prevention Week was observed March 19-25.

In a trend that pediatricians should note carefully in their management of children with atopic dermatitis (eczema), dermatologists likely will exercise more caution in prescribing the topical calcineurin inhibitors (TCIs) Elidel cream (pimecrolimus, Novartis) and Protopic ointment (tacrolimus, Astellas Pharma) in response to the Food and Drug Administration's decision to add "black box" warnings to these drugs' labels, an expert pediatric dermatologist told the publication Dermatology Times recently.

Parents have another good reason to make sure their child gets a good night's sleep: Recent research suggests that children who do not get enough sleep may be at higher risk of becoming overweight than those who watch too much television or never exercise.

A rise in asthma exacerbations and hospitalizations in the fall is related to the start of school and a subsequent increase in viral infections among children. Attempting to improve asthma control and reduce the transmission of infections as school starts could reduce the annual September asthma epidemic, according to research published in the March 2006 issue of the Journal of Allergy and Clinical Immunology (JACI).

Day-old boy born at term via vaginal delivery complicated by shoulder dystocia. He had very mild cyanosis in the extremities at birth, which resolved after 5 minutes. Referred for evaluation of respiratory distress. Birth weight, 3.3 kg (7.4 lb). Apgar scores: 7 at 1 minute, and 9 at 5 minutes.

Vaccines show great promise for primary prevention of human papillomavirus infection, but effective screening, using the latest guidelines, and education are still key. Second of two parts.