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Supracondylar ProcessA 10-year-old boy injured his left elbow during football practice. He subsequently had pain with normal range of motion of the elbow.
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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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Intussusception With a Pathological Lead PointA 4-month-old girl was admitted to a rural hospital with nonbilious vomiting and bloody stools that began the prior evening. The parents reported that the infant had periods of excessive irritability mixed with periods of calm. She had no fever, exposure to illness, or surgical history.
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Tinea Capitis and Tinea CorporisA 16-year-old boy complains of an itchy scalp and areas of hair loss. Physical examination reveals a 2- to 3-cm patch of alopecia studded with black dots, as well as posterior cervical and occipital lymphadenopathy.
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Hip Pain in a Teenaged GirlA 17-year-old girl presented for evaluation of right hip pain. Several months earlier she had incurred a twisting injury to her hip when she landed from a jump while dancing.
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A Guide to Monitoring and AchievingAsthma Control in ChildrenYounger Than 5 YearsAsthma is the most prevalent chronic disease in children. In the United States, asthma affects approximately 1.4 million children younger than 5 years and causes frequent activity limitations and hospitalizations.
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To Tie or Not to Tie: The Dilemma of the Supernumerary DigitAn 11-day-old African American boy was brought in for a well-baby visit. Pregnancy, labor, and delivery had been uncomplicated.
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A 3-Year Old Girl with a Rash on Left Arm, Flank, and ThighA 3-year old girl presents with a 4-week history of rash on her left arm, flank, and thigh. The rash is non-pruritic and non-painful. The patient is taking no medications and is up-to-date on all immunizations.
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Resistant "Diaper Rashes"The photos presented this month reveal disease entities I have seen that did not respond to conventional therapy and that became resistant "diaper rashes." You may have seen some of these "bottoms" in previous issues of Consultant For Pediatricians. Next to each photograph, I have given several clues to the diagnosis. See if you can match these clues with the diagnostic choices listed below. You can check to see whether your diagnostic choices are correct on page 61.
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Atypical Tuberculin Skin Test ResponsesTwenty-four hours after receiving a standard 5-unit purified protein derivative of tuberculin (PPD) skin test, a young African American presented with a slightly pink, raised, firm plaque at the site of the injection (A). His previous PPD test results were negative. He denied any constitutional symptoms and rashes. He was otherwise healthy, was not taking any medication, and was HIV-negative.
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Botfly InfestationFive weeks after returning from a school trip to the Amazon in Peru, a 16-year-old boy presentedwith 2 persistent “bug bites” on the lateral left calf. He had sustained multiple bug bites duringhis trip, all of which had resolved spontaneously except for the 2 on his lower leg.
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Fever and Neck Swelling in a Toddler With Growth DelayA 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.
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Dog BiteThe 2-year-old boy shown here had been bitten on the left cheek by a medium-sized dog while at the home of his day-care provider. Immediately after the incident, the child was examined by his pediatrician and given a presciption for amoxicillin clavulanate. The next day, he presented to the emergency department with worsening cellulitis of the left cheek.
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Obesity in pediatrics: perspectives from a pediatrician and a pediatric nurse practitionerTwo pediatric health care providers offer best practices for treating patients with obesity.
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Update on Pediatric RheumatologyABSTRACT: Dramatic progress has been made in our understanding of pediatric rheumatic disease. Various classification systems help identify juvenile idiopathic arthritis (JIA), which involves unique considerations that distinguish it from rheumatoid arthritis in adults. Vaccination issues are important for children with JIA. Renal involvement with systemic lupus erythematosus (SLE) is more common and more severe in children than in adults, but treatment of children who have SLE is similar to that of adults. Neonatal lupus erythematosus may occur in infants whose mothers have SLE. Juvenile dermatomyositis is associated with significant morbidity and mortality. Kawasaki disease is a common vasculitis of childhood, especially in infants and toddlers. Each of at least 8 major familial periodic fever clinical syndromes has specific distinguishing characteristics.
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Infant With Persistent Fever and Cough, Worsening RashA 14-month-old girl presented with persistent fever, cough, and worsening rash of 5 days’ duration. On the first day of the illness, the infant was brought to an acute care clinic for evaluation.
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Autism Spectrum Disorders: 5 Things Pediatricians Should KnowAutism spectrum disorders affect 1 in 100 children and the prevalence is 3 times higher in females. One-third of all children with autism have seizures.
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Cardiovascular Disease Screening Misses At-Risk YouthHypercholesterolemia, atherosclerosis, and coronary artery disease are ever-growing problems in our society. While these “adult” medical issues rarely concerned pediatricians in the past, it is now well recognized that these troublesome processes begin in childhood.
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6-Month-Old Girl With Genital MassChild Protective Services (CPS) has asked you to evaluate a 6-month-old girl with a genital mass. The goal is to determine whether the "weird lump in the baby's private area"--noted while the child's diapers were being changed in day care--was the result of sexual abuse.
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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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Child Near Expulsion From Preschool: Is Medication the Answer?My 3-year-old son slaps and bites other children at preschool. His teacher says he is too hyperactive and needs medicine to calm him down.
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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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Green Teeth in a Child With HyperbilirubinemiaA 26-month-old girl presented to the general nephrology clinic for evaluation of chronic renal insufficiency. During the examination, the physician noted green discoloration of the teeth.
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ADHD Treatment Driven by Parents’ PreferencesFor children with ADHD, assessing parents’ preferences and goals is useful for clinicians in understanding which treatment parents are likely to initiate for their children.
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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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Bilateral Iris ColobomasThe patient's medical history was unremarkable. He had been born via normal vaginal delivery. His father had a history of strabismus. The child had fix-and-follow vision in both eyes. Extraocular muscle movement appeared normal. A Hirschberg test showed orthophoria. A Bruckner test showed symmetrical red reflexes in both eyes. Cycloplegic refraction revealed moderate hyperopic correction, which was symmetrical in both eyes. No retinal or optic nerve head defects were noted on dilated fundus examination.
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Complications of Body ArtHenna and Hair DyeA 16-year-old Somali girl presented with a 30-day history of bilateral arm swelling and painful vesicular eruptions.Five days before presentation, she and her friends had used henna and black hair dye to “tattoo” their skin. Theothers did not experience similar signs or symptoms. This patient had used henna since childhood for decorativepurposes. However, outlining an intricate design with hair dye was new for her.This patient was hospitalized and treated for severe cosmetic dermatitis with systemic corticosteroids,diphenhydramine, and daily dry dressing changes. Ibuprofen was given to help relieve discomfort. Antibioticswere not ordered.The patient remained afebrile and was discharged on hospital day 2 with close follow-up and daily dressingchanges. She was advised to avoid contact with all hair-dye products.Case and photo courtesy of Jennifer A. Jewell, MD, and Lorraine L. McElwain, MD.
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Genetic Disorders: Newborn With Multiple AnomaliesGenetic Disorders: Newborn With Multiple Anomalies
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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.
