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Conflicting Recommendations for Lipid Screening and Management in Children: The Need for ConsensusIn July 2008, the American Academy of Pediatrics (AAP) updated their recommendations on lipid screening and cardiovascular health in childhood.1 The new recommendations created a media stir because of the endorsement of the use of statins in certain at-risk children as young as 8 years.
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Photoclinic: Corneal AbrasionOn waking up from a nap, a 5-month-old infant was noted to have a watery right eye. The mother thought an eyelash was the problem and flushed the eye with water. Soon afterward, the eye watered again and began to close. There was no history of injury, foreign body, upper respiratory tract symptoms, or fever.
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A Toddler Intolerant of Tube FeedingA 22-month-old boy with failure to thrive presented with a 3-day history of rhinorrhea, fever, and abdominal pain associated with tube feeding. A PEG tube had been placed 2 months before this visit.
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Cough and Cold Treatments for Children:Despite the plethora ofover-the-counter cough and cold medicationsdesigned to relieve a variety ofsymptoms of the common cold-primarilynasal congestion, rhinorrhea, and cough-no treatment has been shown to have anybeneficial effect in children, and some maycarry a substantial risk of adverse effects.Even routine symptomatic therapies suchas antipyretics and humidified air maybe counterproductive. Parental educationis the best medicine. Parents need tounderstand the duration and expectedsymptoms of the common cold. Advisethem about specific changes in symptoms(eg, rapid or labored breathing) or duration(eg, a cold lasting 10 days or morewithout improvement) that would warranta re-evaluation by their child's physician.Parents also need to be educated aboutthe lack of proven efficacy and the potentialadverse effects of available cold remedies.Saline nose drops and adequate fluidsas well as antipyretics for bothersomefever may provide limited symptomatic relief,but time is still the only known cure.
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Perianal Finding--Sexual Abuse or Normal Variant?A 23-month-old girl was brought to the pediatrician's office by her mother who was concerned about "bulging down there." The child's mother reported that a "bump" had been present in the girl's diaper area since her birth and that it had been growing.
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Foreign-Body Aspiration: A Guide to Early Detection, Optimal TherapyABSTRACT: Because foreign-body aspiration can cause symptoms that mimic those of other respiratory conditions, a high index of suspicion is crucial in all children who have pneumonia, atelectasis, or wheezing with an atypical course--especially when these conditions are unresponsive to usual medical therapy. A history of choking can usually be elicited in a patient who has aspirated a foreign body: such a history should be sought when respiratory symptoms develop suddenly. However, the absence of a choking history does not rule out foreign-body aspiration. Moreover, patients may be asymptomatic initially. Normal radiographic findings do not exclude an aspirated foreign body. Bronchoscopy should be strongly considered when an aspirated foreign body is suspected, even if radiographic images show normal findings. Rigid bronchoscopy is the procedure of choice for removing aspirated foreign bodies in children. Prevention of foreign-body aspiration can be enhanced through anticipatory guidance of parents/caregivers and through continued product safety efforts.
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Sialoadenitis in a TeenagerFifteen-year-old girl with several- day history of worsening right-sided facial pain and swelling. Pain severity 10 on a scale of 1 to 10. Limited oral intake.
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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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Differentiating Epileptic Seizures From Nonepileptic SpellsIt can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Children with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events.
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A Wormian Bone in a NeonateWormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.
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Can You Distinguish Among These Diaper Dermatoses?Match the photographs of the rashes with the correct diagnosis.
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Snippets of Vaccine History: Success, Failure, and ControversyVaccination against infectious diseases has saved millions of lives. The recurrent threat of influenza pandemics and the prevalence of global HIV infections underscore the need for better-designed, more effective vaccines.
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Jacquet's Dermatitis: An Unusual Type of Diaper RashJacquet’s dermatitis a rare, severe variant of irritant diaper dermatitis, presents with punched-out erosions or ulcerations with crater-like borders.
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Neonatal Testicular TorsionOn examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable.
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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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Warding Off the Common Cold in Young ChildrenDr Pytlak offers tips on what parents can do to protect the whole family from colds and flu this season with some seasoned home remedies.
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Henoch-Schönlein purpura with gastric wall thickeningFor 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
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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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Musculoskeletal Clinics: 16-Year-Old Camper With Tibial PainA 16-year-old boy complains of right lower leg pain that began 2 weeks earlier, after his first week at a summer basketball conditioning camp. Before he left for the camp, he was jogging off and on, averaging a few miles a week. At camp he began running 7 miles a day and doing sprints 3 times a week.
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Juvenile Laryngeal Papillomatosis: An Unexpected Cause of StridorThe patient had been born at term following an uncomplicated pregnancy and labor. Her growth and development were appropriate. Her immunizations were up-to-date. At about 1 year of age, she began to have "wheezing" episodes. Moderate persis- tent asthma was diagnosed, and treatment with fluticasone and inhaled albuterol was initiated.
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Morgagni HerniaA 16-year-old boy with Down syndrome was referred for evaluation of nonspecific symptoms, including difficulty in breathing on standing up from a sitting position, dizziness, frequent abdominal pain, and diarrhea after ingesting fatty foods and milk. He had intermittent asthma exacerbations for which he occasionally used a β-agonist. He had no history of trauma, surgery, or allergies.
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Full case: 21-month-old with history of “skin tags” on her gluteal cleftRead the full case presentation of a 21-month-old with a history of "skin tags" involving her gluteal cleft,noted at birth.
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Frey SyndromeEpisodic right-sided facial flushing was noted in a 2-month-old girl born at full term via forceps-assisted vaginal delivery. The erythema appeared within minutes of latching onto her mother’s breast and resolved within 5 to 10 minutes after breastfeeding. The episodes of flushing had begun a week before the clinic visit; there were no collateral symptoms of anaphylaxis. Because food allergy was suspected, the mother had eliminated all dairy products from her diet.
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Herpetic Lesions Primary Herpetic Stomatitis Herpetic Whitlow Recurrent Herpes in Uncharacteristic LocationsA 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.
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A New Zip in Playground InjuriesWhile playing on the school playground, a 10-year-old boy decided to try a zip line. He grabbed the pulley and slid down the cable. When the pulley came to a stop, he fell off and sustained a right ankle injury.
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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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Cystic Hygroma in a 1-Year-Old GirlThe parents of this 1-year-old girl brought her for evaluation of a neck mass of sudden onset (A). They had first noticed the mass on the morning of presentation. The child had cold symptoms and had been snoring, but she had no history of fever, shortness of breath, wheezing, or stridor. Her activity level and appetite had not changed.
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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.
