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Green-Colored StoolThe parents of a 7-month-old girl brought their daughter for immediate medical attention after she passed bright green-colored stool. For the past 24 hours, the child had mild fussiness and a low-grade fever (temperature, 38.1°C [100.6°F]); she also had vomiting and mild diarrhea, with yellow-colored stools. The mother was advised to begin small, frequent feedings of oral rehydration solution with gradual return to the baby's normal diet, as tolerated. Over the next 12 hours, the vomiting and fussiness decreased and the fever resolved, but the mild diarrhea persisted and stools turned bright green. The parents denied giving the child green-colored drinks or food.
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Dog Bite in a Penicillin-Allergic PatientThe patient, a 14-year-old boy, comes to see you the same day he was bitten by a dog. In the examination room, you find him seated comfortably in the chair with his right hand and arm bandaged.
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Snakebite EnvenomationWhen reaching under a shed for the frog she had been chasing, a 4-year-old girl was bitten by “something.” The parents thought the bite was from a snake because of reports of copperhead sightings in the area. The mother immediately brought the child to the emergency department (ED).
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Keratoconus With Acute HydropsThis 14-year-old boy with autism presented with sudden visual loss in the right eye. For a week, the eye had been red, irritated, and painful. Three days earlier, "a white bubble" had developed on the cornea and had begun to obscure his vision.
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ADHD Medications: A Look at Their Safety ProfileEach year in this country, physicians prescribe medications to treat ADHD in nearly 3 million children. The safety of these agents has been the subject of some debate.
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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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Case in Point: Infant With an "Atypical Mole"A 6-month-old infant was brought for evaluation of an "atypical mole" on the chest that her parents and referring physician feared might be skin cancer. The parents reported that the lesion had been present since shortly after birth and had become red and inflamed after minor trauma on a few occasions and once had blistered.
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Photoclinic: Tinea CapitisThe parents of a 3-year-old girl sought evaluation of their daughter's hair loss. During the past several months, a large patch of alopecia with scaling had developed. The differential diagnosis included seborrhea, trichotillomania, and tinea capitis. Joe R. Monroe, PA-C, MPAS, of Tulsa, Okla, writes that in seborrhea, scaling typically occurs throughout the scalp without the patches of alopecia seen in this patient. Broken-off hairs--a key to trichotillomania--were absent here. A potassium hydroxide preparation of scrapings that contained hairs from the affected area were positive for the "endothrix" phenomenon--the finding of fungal elements inside the hair shaft. Palpable, tender suboccipital lymph nodes were also detected. Both of these findings are common in tinea capitis and essentially confirm the diagnosis.
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Emergent Laceration ClosureDr Crane and Mr Schoonmaker, who were at the campground, write that an inordinate amount of highway traffic resulting from a local bikers' rally prevented them from transporting the patient to a medical facility. Emergent wound closure had to be performed with available materials. After the wound was flushed, a household cyanoacrylate adhesive, Krazy Glue, was used to close the laceration. To add lateral support and to reduce the risk of wound dehiscence, Dr Crane embedded hair trimmed from the patient's scalp into a second layer of glue. To replicate wound closure tape, the hair was applied perpendicular to the laceration. Azithromycin suspension was available; 1 tsp (5 mL) was given initially followed by 2.5 mL daily for 4 days.
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Two Teens With Retrosternal Chest Pain and OdynophagiaA previously healthy 14-year-old girl presented with retrosternal chest pain, odynophagia, and dysphagia of 10 days' duration. Her medical history was unremarkable. Results of an ECG and a chest radiograph were normal. An upper GI series revealed an abnormality at the level of the mid esophagus. She was treated with lansoprazole and sucralfate for a week; however, her symptoms persisted and perhaps worsened slightly. She lost 2.3 kg (5 lb) during her illness and was referred to a pediatric gastroenterologist.
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Genetic Testing for Autism: What Can Be Done, How Helpful Is It?In this podcast, Dr John Harrington of Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters, and Dr Michael Paul, CEO and Rena Vanzo, Genetic Counselor of Lineagen-provider of a new integrated genetic testing and counseling service FirstStepDx-discuss the diagnosis of autism and genetic testing for autism.
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Cerebral Palsy: A Multisystem ReviewABSTRACT: Most cases of cerebral palsy (CP) are the result of congenital, genetic, inflammatory, anoxic, traumatic, toxic, and metabolic disorders. A minority of cases result from asphyxia at birth. Nearly three-quarters of children with CP aged 7 years had a normal neurological evaluation at birth. Abnormal motor development usually provides the first diagnostic clue. Neuroimaging is recommended if the cause of CP has not been established with perinatal imaging. MRI is preferred to CT. Management of the multisystemic manifestations begins with a comprehensive medical evaluation by a multidisciplinary team that includes family members. Therapy is aimed at maximizing the patient's level of function. Key areas include ambulation, cognitive skills, activities of daily living, hygiene, and rehabilitation into society.
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Podcast: 5 Myths About Office-Based Spirometry-and Why You Really Do Need This Essential ToolIn this podcast, Dr John Kelso dispels myths and makes a case for office-based spirometry for pediatricians.
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How to Interpret Office Spirometry (Part I): 5 Criteria for Interpreting Flow-Volume CurvesRegular spirometry to monitor lung function ensures successful asthma management-even in children. Here, a refresher for pediatricians on how to evaluate flow-volume curves.
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Pediatric Musculoskeletal Infections: Managing the Significant OrganismsMusculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial.
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Caterpillar StingWhile playing on a brick walkway in her backyard, a 4-year-old girl stepped on a puss caterpillar and was stung. The ecchymosis exactly outlined the caterpillar's spines and remained visible for at least 3 months. The initial sting caused intense pain that lasted for more than an hour.
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Newborn With Wrinkled Abdomen and Other AnomaliesPrune belly syndrome is a rare condition, classically referred to as a triad of abdominal wall musculature deficiency, bilateral cryptorchidism, and other urological abnormalities, although the clinical presentation can vary. A case history here.
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Apert Syndrome in an InfantAfrican American girl born at 36 weeks' gestation to 24-year-old primigravida via spontaneous vaginal delivery at a community hospital. Apgar scores, 7 at 1 minute and 9 at 5 minutes. Grossly normal placenta, with a 3-vessel cord. On the second day of life, infant required several minutes of blow-by oxygen for a desaturation event and subsequent transfer to a level III neonatal ICU for further monitoring.
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Case In Point: Pneumatosis Cystoides Intestinalis: An Unusual Radiographic FindingA 14-year-old girl was referred for evaluation of a several-year history of growth failure, chronic abdominal pain, and intermittent emesis. The parents described the child as a "picky eater," and various foods (eg, meat products and beans) frequently caused abdominal distention.
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Toddler With Progressive Proptosis From Acute Myelogenous LeukemiaA few days before presentation, the mother noted some "bumps" that had developed behind the child's right ear. The child was brought to the emergency department for evaluation.
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Torticollis and Fever: A Case of Grisel Syndrome From Group A Streptococcus InfectionA previously healthy 2-year-old boy was hospitalized after 2 weeks of persistent fever (temperature to a maximum of 38.9C [102F]) and a 2-day history of neck stiffness. There was no history of cough, rhinorrhea, or dysphagia. The oropharynx could not be examined because of neck stiffness. The patient had bilateral anterior cervical lymphadenopathy.
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Bilateral Tibial HemimeliaBoth autosomal dominant and recessive patterns of inheritance have been proposed.2 Bilateral tibial hemimelia has also been associated with CHARGE syndrome and Langer-Giedion syndrome and may be linked to several loci on chromosome 8.4,5
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Subclavian Central Venous Catheter Fracture and EmbolizationThe imaging studies shown are from 2 children with cancer who underwent placement of 9.6 French left subclavian central venous catheters (CVCs) to facilitate treatment. Fracture of the catheters with subsequent embolization of the distal fragment to the pulmonary arteries was noted at about 18 months after placement. Findings suggestive of impending fracture were missed in previous radiographs. In both cases, an interventional radiologist removed the fragment via percutaneous catheterization of the right femoral vein.
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Treating Patients with Trichotillomania and Other Related BehaviorsDr Jon E. Grant talks about the genetics, neurobiology, and cognitive processes of body-focused repetitive behaviors, which include trichotillomania, skin picking, and other behaviors.
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Emergent Laceration ClosureDr Crane and Mr Schoonmaker, who were at the campground, write that an inordinate amount of highway traffic resulting from a local bikers' rally prevented them from transporting the patient to a medical facility. Emergent wound closure had to be performed with available materials. After the wound was flushed, a household cyanoacrylate adhesive, Krazy Glue, was used to close the laceration. To add lateral support and to reduce the risk of wound dehiscence, Dr Crane embedded hair trimmed from the patient's scalp into a second layer of glue. To replicate wound closure tape, the hair was applied perpendicular to the laceration. Azithromycin suspension was available; 1 tsp (5 mL) was given initially followed by 2.5 mL daily for 4 days.
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Case in Point: Acute Osteomyelitis: Radiographs Versus MRIA 10-year-old boy with no medical history was brought to his pediatrician's office with a 2-day history of intermittent fever (temperature of 38.8°C to 39.4°C [102°F to 103°F]). Physical examination results were unremarkable. There was no history of recent trauma. The child was sent home with analgesic therapy.
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Case in Point: Child With Dysphagia, Fever, and Weight LossA 5-year-old African girl, whose family lived in France, was brought to the emergency department of our hospital during a family visit to the United States. The child had a 1-week history of difficulty in swallowing, a temperature of up to 38.3°C (101°F), and rhinorrhea. She had lost 4 lb during the week. According to her mother, the patient had no history of cough, nausea, vomiting, diarrhea, abdominal pain, or sick contacts.
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A Brain Tumor Presenting as Chronic Intermittent StridorA 2-year-old previously healthy girl was brought to her pediatrician with the chief complaint of persistent noisy breathing. Two months earlier, the child had an upper respiratory tract infection (URI) with rhinorrhea, cough, noisy breathing, and wheezing. All symptoms had resolved except the abnormal breathing. Physical examination findings were unremarkable. A lateral neck x-ray film demonstrated subglottic narrowing, thought to be consistent with croup. Laryngoscopic examination by an otolaryngologist did not reveal any pathology.
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TrichotillomaniaA10-year-old boy was brought to a medical mission clinic in Roaring Creek, Belize, for evaluation of bald spots on his head. The mother reported that the bald areas seemed to be worsening because of the child's uncontrollable desire to pull out his hair.
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Leg Size Asymmetry in a ToddlerTwo-year-old girl with asymmetry of leg size at birth; left leg is larger than right. The size discrepancy has remained relatively constant since birth, with no sudden change in overgrowth of the affected limb.
