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The Practice of Nonsuicidal Self-injury in Adolescents-Part 2In Part 2 of this podcast series, Dr Smith continues his discussion of the practice of nonsuicidal self-injury in adolescents.
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X-Linked IchthyosisA 4-year-old boy was referred for evaluation of refractory eczema that first appeared at 1 month of age.
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Hydrocephalus Secondary to GBS MeningitisA female infant born at 29 weeks' gestation after premature membrane rupture was admitted to the neonatal ICU in respiratory distress.
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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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Observation and Documentation Still the Foundation of Medical PracticeIn this age of evidence-based medicine and randomized clinical trials, it is easy to forget that careful clinical observation and documentation are the foundation of medical practice.
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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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Young Boy With Painful Swelling of the Eye and ForeheadFor several days, a 9-year-boy has had painful swelling on the top and left side of his forehead, bilateral eye swelling, intermittent fever, and nasal congestion. He was seen in the office 4 weeks earlier, after he had hit his left eye on a school desk. At that time, he presented with a left retro-orbital headache, nasal congestion and discharge, and intermittent fever.
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Foreign Body in the TonsilThe mother of an 8-year-old boy sought medical care for her son, who had complained of a sore throat for 3 days. No fever, drooling, rash, rhinorrhea, cough, congestion, ear pain, neck stiffness, or dyspnea was reported. The boy had not been in contact with any ill persons, although his complaints coincided with a local outbreak of streptococcal pharyngitis.
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Unilateral Laterothoracic ExanthemThis erythematous, blanching papular rash developed on the trunk of a 20-month-old boy 3 days after he became ill with a low-grade fever (temperature of 38.3ºC [101ºF]) and mild upper respiratory tract infection symptoms.
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What'sYour Diagnosis?Ten-month-old girl with swelling of the left knee of 7 weeks' duration. Unable to bear weight on the left leg for the past 2 weeks. No fever or history of trauma to the area. Infant has good appetite for breast milk and formula, but possible malaise.
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Genetic Disorders: Toddler With Skeletal, Ocular, and Cardiac AnomaliesA 15-month-old girl presents for evaluation of macrocephaly and unusual facial features. Her prenatal and natal history are unremarkable. The child is now developing normally after mild gross motor delays during the first 6 months of life. Mild scoliosis was noted on a babygram taken at 8 months during an evaluation for possible nonaccidental trauma.
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Acute Lymphoblastic Leukemia Presenting as Soft Tissue MassFor 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.
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Hypersensitivity to Vaccine StabilizerA 5-year-old boy with seizure disorder and developmental delay presented to our allergy and immunology clinic for a severe reaction that developed after he had received multiple vaccines. One month before our evaluation, the patient had been vaccinated against varicella, hepatitis A, and influenza at his pediatrician's office. Latex gloves were not used for vaccine administration.
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Case In Point: Infant With Aldosterone DeficiencyA 45-day-old boy was referred for evaluation of persistent hyponatremia and hyperkalemia. On the 9th day of the boy's life, his serum potassium level was elevated (8 mEq/L) and on the 12th day, his serum sodium level was low (131 mEq/L). Supplementation with sodium chloride was initiated.
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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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Evidence of Benefits of Allergy Assessment in Patients With AsthmaThe most common chronic medical problem that we pediatricians treat is asthma. We do our best to manage our patients' asthma by prescribing controller medications, providing asthma action plans, and guiding families through acute exacerbations. We often ask about possible environmental triggers, such as tobacco smoke and cockroaches, and we advise patients to reduce their exposure to those triggers.
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America's "Obesogenic" MessType 2 diabetes, once considered a disease of “adult onset,” is highly resistant to treatment in overweight American youth-a group succumbing to the disorder at an alarming rate.
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Infant With Persistent Fever and FussinessA 4-week-old boy with tactile fever for the past 24 hours and fussiness of 2 weeks' duration is referred to the emergency department (ED).
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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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Photoclinic: Foreign-Body IngestionA 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.
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Aberrant Right Subclavian ArteryAn African American baby girl was noted to have noisy breathing at birth. The infant had inspiratory stridor while awake and no audible stridor while asleep. Birth weight was 3.20 kg (7.11 lb). She had been formula fed for the first 2 weeks of life and had intermittently vomited after feedings.
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Photoclinic: CephalhematomaA male neonate was born at 39 weeks' gestation by vertex vaginal delivery with focal swelling of the head. Vacuum extraction and forceps were not necessary for delivery. The mother had no complications during labor. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. A cephalhematoma was suspected when the fluctuant parietal swelling did not transilluminate.
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Osteomyelitis Associated With Cat-Scratch DiseaseA 3-year-old girl was hospitalized because of purulent drainage from a right middle finger wound (Figure 1) and a tender right axillary mass (Figure 2) of 2 days’ duration.
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Photoclinic: ScaphocephalyThis 9-month-old infant was brought for evaluation of anteroposterior elongation of the cranium. The infant was born at term via uncomplicated vaginal delivery. His mother had noticed that his head was more elongated and narrower than his sibling's. He had achieved appropriate motor and social milestones for his age. Neither parent had a family history of abnormal head shape. The rest of the examination findings were unremarkable.
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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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Sacral Epidermal Anomalies in an InfantTwo-month-old boy with divot in the lower back, shown here with the gluteal crease relaxed (A) and spread (B). Infant is a product of an uncomplicated pregnancy and delivery. Nursery stay uneventful. Subsequent feeding and growth normal. Parents report no problems with urination or defecation.
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LEOPARD SyndromeThis 7-year-old boy was brought in for a routine well-child visit. His history included profound sensorineural hearing loss, (for which he had received cochlear implants) and congenital heart disease (a small ventricular septal defect, subaortic ridge, right ventricular conduction delay, and mild left ventricular dilatation).
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Epidermal Inclusion CystsThese 2 swellings on the scalp of a 13-year-old boy had appeared about 8 months earlier and had slowly enlarged. The mother had massaged the lesions when they were small in an attempt to heal them. There was no history of local trauma (eg, from hair-cutting tools) and no pain or discharge from the lesions.
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With Bronchiolitis Season in Full Swing, New Insights into Factors Affecting SeverityAlthough bronchiolitis is commonly seen in very young children, the infection can be dangerous and even fatal for some infants. Here, new thoughts on risk factors that may determine which babies get very sick.
