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Segmental form of mosaic neurofibromatosis 1A healthy 16-year-old girl presented with asymptomatic lesions she had at birth. Examination revealed a 15 cm well-demarcated light brown hyperpigmented background patch localized to the right inguinal skin-fold and, within it, café-au-lait macules and patches, greater than 1.5 cm, with diffuse freckling.
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Four tips for succession planning at your medical practiceDon't wait until it's too late to start planning for practice succession.
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Navigating the current shortages of pediatric ADHD medicationsUnderstand how to naviate the current shortage of pediatric ADHD medications.
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Jillian Cotter, MD, MSCS, on recent advances in pediatric pneumonia management"We've updated our internal clinical pathways to recommend 5 days for kids hospitalized with uncomplicated pneumonia," Cotter noted.
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Rainbow resilience: Addressing the mental health needs of sexual- and gender-diverse youthResearch has demonstrated that SGDY exhibit significantly elevated incidence of mental health diagnoses and conditions compared with their counterparts, including higher rates of suicidality, depressive and anxiety disorders, and substance misuse.
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What's next for interoperability?As health care leaders navigate our transition from life in a pandemic to a world where COVID-19 is an endemic disease, interoperability will likely be top of mind.
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The latest innovations to improve medication adherenceFrom smart pills to augmented intelligence, technology has presented the health care industry with a host of options to improve medication adherence and safety.
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Final Thoughts on the Management of Pediatric ADHDRobert L. Findling, MD, MBA; and Timothy Wilens, MD, share advice on the treatment of pediatric ADHD and new agents in the pipeline.
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Photoclinic: EuryblepharonDuring a neurologic evaluation for seizures, a 17-year-old boy with epilepsy was noted to have a deformity of both lower eyelids. According to the boy's mother, the deformity had been present since birth; it was not related to the patient's neurologic condition.
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Bone Pain, Bruising, and Epistaxisin a Young BoyA 5-year-old boy was brought for evaluation of ongoing thrombocytopenia before undergoing adenotonsillectomy for obstructive sleep apnea. The child had been given a diagnosis of "growing pains" after frequent evaluation for leg pain over the past 2 years.
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Two-Year-Old Boy With Ataxic Gait and Markedly Elevated Liver Enzyme LevelsA 27-month-old boy is brought by his mother to the emergency department (ED) with a 1-day history of sluggish behavior and unsteady gait. The child had been sleepy but was arousable.
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Orbital Blow-Out FractureVital signs were normal. The patient had left-sided periorbital edema with slight ecchymosis and enophthalmos. There was conjunctival injection of the left eye, but no hyphema was noted. Pupils were equal, round, and reactive. Extraocular muscles revealed some restriction with upward gaze. Tympanic membranes were intact without hemotympanum. Nasal and oral examination findings were normal.
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Photoclinic: MRSA Skin Abscess and OsteomyelitisThis lesion on the chest of a 6-week-old infant had developed over 2 days (A). It began as a small mass just below the right nipple. Initially, there was no tenderness or erythema; within 2 days, the lesion had begun to drain green-yellow and then white purulent exudate.
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Young Girl With Enlarging Tender Neck MassA 6-year-old girl presented with tender mass on the left side of her neck that had enlarged over the past week. Her primary care doctor initially prescribed amoxicillin/clavulanate for suspected bacterial lymphadenitis. The swelling progressed, and a CT scan was ordered.
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Treatment of ADHD: A Developmental ApproachAttention deficit hyperactivity disorder (ADHD) is very common. In the United States, between 6% and 10% of children and adolescents are affected, as are 4% of adults.1 Children in other countries also have ADHD, although rates of comorbid disorders may vary from those found in the United States.2
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Left-Sided Appendicitis in an 11-Year-Old GirlAn 11-year-old girl was brought to the emergency department (ED) after 3 days of intermittent, dull, nonradiating left lower abdominal pain. She also had 3 episodes of nonbloody, nonbilious emesis in the 2 days before presentation. Three days earlier, the patient had been vaccinated against influenza and varicella by her pediatrician.
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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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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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Sunflower Seed IngestionSeveral hours before he was seen in the office, a 2-year-old boy passed stool that contained a large intact sunflower seed. He had poor appetite and abdominal cramps but no recent history of emesis or fever.
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Pityriasis Rosea in Dark-Skinned ChildrenIn the course of studying azithromycin as a treatment for pityriasis rosea (PR) which we found does not work, we collected much data on the distribution, morphology, and course of the lesions.
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New-Onset Seizures in Infant With Square Facies, Hypospadias, and Hirschsprung DiseaseA 6-month-old boy with dysmorphic facial features, ear anomalies, and hypospadias brought for evaluation of elevated temperature and generalized seizure. Infant born at term to a 37-year-old mother via uncomplicated cesarean delivery.
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Diagnostic Challenges Associated With Pediatric Tuberculosis: 2 CasesA 10-week-old white baby girl with a history of difficulty in breathing presented with stridor, tachypnea, wheezing, and increased work of breathing.
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Hill-Sachs Deformity: A Pathognomonic Sign of Anterior Shoulder DislocationA Hill-Sachs deformity is a compression injury to the posterolateral aspect of the humeral head created by the glenoid rim during dislocation.
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Photo Finish: Acute Dx: What Cause of Sudden Illness? rhus dermatitisA 4-year-old girl presents with a highly pruritic rash. The day before, she had been playing outdoors at her grandmother's house. No pets were present, and the patient does not recall being stung or bitten by insects. There are bushes on the grandmother's property.
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Pediatric Vasculitic Syndromes:A 7-year-old boy presented to his primary care pediatrician with a 24-hour history of vomiting, abdominal pain, and low-grade fever. The child appeared stable. A viral illness was diagnosed. The child was sent home, and his parents were advised to give him adequate fluids as well as acetaminophen as needed for fever.
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Labial FusionThe mother of this 11-month-old girl was concerned that her infant’s vagina was almost obscured by a membrane. This was noted incidentally a few days earlier.
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Internal Jugular PhlebectasiaA 16-year-old girl with internal jugular phlebectasia presented for followup ultrasound evaluation. At age 15 months, she was noted to have a right-sided neck mass that appeared when crying or straining. Her weight, height, and head circumference were normal. She had no cardiac anomalies and was otherwise healthy.
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CONSULTATIONS AND COMMENTS: Refractory Diaper Dermatitis? Two Additional Strategies . . .I enjoyed reading the article "Diaper Dermatitis" in your June issue. To the many treatments discussed, I would offer 2 additional management points. First, persistent and/or recurrent diaper rash is more common when children older than 12 months continue to drink from the bottle. Excess fluid intake leads to soppy diapers and often, sloppy stools. When the cup replaces the bottle, diapers and firmer stools ensue--and accompanying rashes disappear.
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Pediatricians Issue Dangerous New Treatment Guidelines For Attention Deficit DisorderDespite its caveats and good intentions, the AAP guideline will surely invite an inappropriate glut of medication for preschoolers . . .
