Prashant Mahajan, MD, MPH, MBA

Sixteen-year-old with a recurrent, painful, pruritic rash on right cheek and right eyelid. Current outbreak started 2 days earlier. The rash always appears in the same fashion and in the same location; it typically lasts a few days and resolves spontaneously.

A 17-year-old Asian male with no significant medical history presented to the emergency department (ED) with acute shortness of breath and associated left-sided chest pain. Symptoms began while the patient was at rest: the pain was sharp and worsened with inspiration. He denied a history of fever, trauma, cough, or any other constitutional complaints.

Chest 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.

A 7-week-old white boy presented to the emergency department (ED) with vomiting and weight loss. His parents brought him to the ED 3 weeks earlier after he had vomited for several days. Possible milk protein allergy was diagnosed at that visit, and a change from cow milk formula to an elemental formula was recommended. Vomiting subsequently increased in frequency. Nonbilious but forceful vomiting occurred with each feeding. The patient lost nearly 2 lb during the 3 weeks that followed the first ED visit.

A 14-year-old boy was brought to theemergency department (ED) by paramedicsafter he complained of dizzinessand an episode of falling down earlythat morning when he awoke to go tothe bathroom.

Pneumonia is one of the most common conditions encountered by primary care providers. Certain organisms cause pneumonia in particular age groups. For example, group B streptococci, Gram-negative bacilli Escherichia coli in particular) and, rarely, Listeria monocytogenes cause pneumonia in neonates. In infants younger than 3 months, group B streptococci and organisms encountered by older children occasionally cause pneumonia, as does Chlamydia trachomatis. Older infants and preschoolers are at risk for infection with Streptococcus pneumoniae and Haemophilus influenzae. In children older than 5 years, S pneumoniae and Mycoplasma pneumoniae are the key pathogens. Let the patient's age, history, clinical presentation, and radiographic findings guide your choice of therapy. Even though most patients with uncomplicated pneumonia can be treated as outpatients, close follow-up is important. Hospitalize patients younger than 6 months and those with complications.