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Concussion in Young Athletes: Heads Up on Diagnosis and ManagementThe increased incidence of sports-related concussion reported nationwide has attracted much media and public attention. Most data about sports-related concussion involve professional, college, and high school level athletes
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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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Rib Fractures: A Case of Abuse in a 6-Month-OldRib fractures suggest abuse and are a lone finding in 29% of skeletal injury cases.
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Case in Point: Methicillin-Resistant Staphylococcal PneumoniaStaphylococcal pneumonia can be a rapidly progressive illness that is commonly associated with pneumothorax and pleural effusion. Affected patients require close monitoring. Consider staphylococcal infection in any infant with pneumonia whose health deteriorates clinically or radiographically.
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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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Orbital CellulitisThis 14-month-old girl was brought for evaluation of marked swelling and erythema of the left eyelids (A) The mother had noticed a green discharge and mild swelling of the eye 2 nights earlier.
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Translocation Down (Trisomy 21) SyndromeSix-year-old East Indian boy delivered by normal spontaneous vaginal delivery to a para 3, gravida 2, 42-year-old mother following uncomplicated, full-term pregnancy. Apgar scores: 9 and 9, at 1 and 5 minutes, respectively. Birth weight, 2.5 kg. Infant hypotonic at birth with numerous dysmorphic features. Delayed developmental milestones; IQ measured at 80.
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Dyskeratosis Congenita: An Inherited Bone Marrow Failure SyndromeAbnormal pigmentation, nail dystrophy, and leukoplakia may signal dyskeratosis congenita.
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Chronic Recurrent Multifocal Osteomyelitis: REFERENCES:ABSTRACT: Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disease that occurs primarily in childhood. The clinical picture often is confused with bacterial osteomyelitis. Awareness of CRMO as a clinical entity helps avoid diagnosis and treatment delays. Our patient, an 8-year-old girl, presented with acute left hip pain. One month after presentation, a lytic lesion was seen on plain radiographs; biopsy revealed nonspecific inflammation. It was not until more than 2 years later, when multifocal bone lesions and psoriasis developed, that the diagnosis became clear. Our patient's case demonstrates several key points: not all children with CRMO present with multifocal disease, patients frequently have comorbid inflammatory conditions, and there are no diagnostic laboratory studies. The optimal treatments remain unknown.
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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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When Johnny Can’t Sleep“My 8–year–old son has always had trouble falling asleep. He never falls asleep before 11 PM, even on school nights. Is there anything you can prescribe so he can get to sleep earlier?”
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Stevens-Johnson SyndromeA 13-year-old boy was brought to the emergency department (ED) with a generalized itchy rash of 2 days' duration. For the past 3 days, he had dry, itchy eyes with a purulent discharge (Figure 1) and nonbilious emesis 2 or 3 times per day, with some blood streaks in the vomitus on the third day of illness.
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PHACE SyndromeAn otherwise healthy female infant presented at birth with a lesion on the left side of the face that involved the frontotemporal scalp, periocular area, nose, and upper lip (A). She was born at term via spontaneous vaginal delivery after an uncomplicated gestation. The initial clinical impression was that of a port-wine stain associated with Sturge-Weber syndrome.
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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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Teen With Multiple BoilsThis 17-year-old presented with multiple boils in the perineum and under breast and skin folds. The lesions produced a malodorous discharge (which caused problems with peer acceptance at school) and were increasing in size. Oral antibiotics had not helped. The patient was admitted for intravenous antibiotic therapy.
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Repeated Episodes of Abdominal Pain Followed by Emesis in a 22-Month-OldTwenty-two-month-old girl seen in the emergency department (ED) after several hours of abdominal pain associated with non-bloody, non-bilious emesis. Over past 2 months, has had 7 or 8 similar episodes of abdominal pain followed by emesis 1 to 2 hours later.
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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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Abdominal Migraines in a 10-Year-Old BoyAbdominal migraine affects up to 4% of the pediatric population and represents 4% to 15% of patients with functional abdominal pain. Most of those affected go on to have migraine headaches.
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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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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Folk Remedy as a Cause of Septicemia in a Child With LeukemiaA 15-year-old Hispanic boy with refractory T-cell acute lymphoid leukemia was hospitalized because of fever and pain and swelling of the right knee of 3 days' duration. The patient was taking nelarabine for a recurrence of his leukemia, which was diagnosed a year earlier. He appeared nontoxic. His temperature was 39.28C (102.68F). Other vital signs were within normal limits. The right knee was warm and tender, with mild restriction of movement.
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Consultations & Comments: Acetaminophen and Asthma: Any Connection?What evidence is there that acetaminophen can cause or exacerbate asthma?
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Childhood Obesity, Part 1: Weight Evaluation and Comorbidity ScreeningMeasurement of body mass index (BMI) is an effective way to screen for obesity and is an important part of the routine health evaluation of all children. A fasting blood sugar test is recommended for obese children 10 years and older who have a BMI above the 85th percentile for their age and sex and 2 high-risk criteria for diabetes (eg, positive family history or signs of insulin resistance). Patients with a BMI at the 85th percentile or higher also require screening for other comorbidities. Such screening includes measurement of waist circumference, blood pressure, lipid levels (specifically, levels of high- and lowdensity lipoprotein cholesterol and triglycerides, as well as total cholesterol), and liver transaminase levels.
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A Young Girl With Unexplained Cervical Lymphadenopathy: Infection? Lymphoma--or Something Else?An 11-year-old African American girl was hospitalized with new fever in the context of unexplained cervical chain lymphadenopathy. WBC and ANC were low, ESR and LDH levels were elevated. Does the image here offer a clue to the ultimate diagnosis?
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Photoclinic: Imperforate Anus With Anocutaneous FistulaDuring their physical examination of this infant who had been born at term via cesarean section, Richard W. Hartmann, Jr, MD, and J. Christiane Salansky, MD, of Halifax Medical Center, Daytona Beach, Fla, found no evidence of an external anal opening (A). A soft bulge was present at the anal site, and the external sphincter was palpable. The median raphe was thick; a drop of meconium was noted on the surface of the perineum midway from the anus to the base of the scrotum (B). The remainder of the examination findings were normal.
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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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Case in Point: Ups and Downs of Trampoline UseA 14-year-old girl came to the office with severe hip pain, which occurred after she attempted a cheerleading maneuver on a trampoline. She reported that she was bouncing as high as she could and landed on the trampoline with her left knee flexed and her right hip extended. On impact, she felt a "pop" that was immediately followed by right hip pain. She could barely move after the landing but managed to get off of the trampoline; she has been walking with pain since her injury.
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Controlling Pediatric Migraine-ContinuedI read with keen interest Dr Jack Gladstein's article, "Pediatric Migraine: Strategies for Maintaining Control," in the August issue of CONSULTANT FOR PEDIATRICIANS (page 316). It prompted several follow-up questions, which I hope the author can respond to.
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Photoclinic: Pathologic Fracture of an Aneurysmal Bone CystRight lower leg pain prompted a 15-year-old boy to seek medical attention. An hour earlier, he had fallen on the leg during a football game and on standing had heard a "pop." No gross abnormality was noted. Jack-Ky Wang, MD, and Laurie Meng, PA-C, of Palos Heights, Ill, report that radiographs revealed a transversing pathologic fracture through an expansile lytic lesion of the right fibula.
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Asymmetric Crying FaciesThis baby boy was born at term to an 18-year-old primigravida via spontaneous vaginal delivery. The membranes ruptured about 6 hours before delivery. The amniotic fluid was heavily stained with meconium. Forceps were not used during the delivery. The newborn initially had poor tone and no spontaneous respirations, but his heart rate exceeded 100 beats per minute. Bulb and deep suctioning as well as supplemental oxygen were provided. Apgar scores were 3 and 8 at 1 and 5 minutes.
