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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.
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Juvenile Nasopharyngeal AngiofibromaSixteen-year-old boy referred to pediatric emergency department (ED) by his primary care physician with a history of headache, blurred vision, and mild proptosis of right eye. Vision: 20/200 OD (right eye) and 20/25 OS (left eye).
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Honors for 4 Pediatric HeroesDr Bhagwan Das Bang received the Pediatric Hero Award at The American Academy of Pediatrics (AAP) National Conference & Exhibition (NCE) in Washington, DC today (October 20, 2009).
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Asthma Therapy Complicated by Peters Plus SyndromeThe authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis.
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Newborn With Urinary DysfunctionDuring circumcision, a newborn is noted to have continuous dribbling of urine from his meatus and stool from his anus. After several minutes of observation, the urinary stream appears weak and remains a constant trickle. The baby boy was born at term via an uncomplicated spontaneous vaginal delivery.
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History of Cough in an Infant and a ToddlerA 6-month-old boy with 1-week history of dry cough that worsened at night. He had been wheezing off and on for the past month and had visited the emergency department on one occasion.
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Henoch-Schönlein Purpura in an 18-Year-Old BoyThis palpable, nontender, nonblanching rash had developed on the elbows of an 18-year-old boy and spread to the ankles and feet. The rash was accompanied by moderate abdominal pain associated with episodes of nonbloody emesis that did not change with eating or bowel movements. Diffuse joint pain developed the day after the rash appeared.
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Consultations & Comments: A "New" Twist on the Technique of Umbilical Catheterization?We heard from several readers about a Photo Essay we recently published in our February issue entitled "The Butterfly Technique: A New Method of Inserting an Umbilical Vessel Catheter."1 The authors, Lisa A. Wood, MD, and Mark J. Polak, MD, described modifications of standard catheter insertion techniques that facilitated successful line placement.
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Asthma Update: Pearls You May Have MissedABSTRACT: Asthma is a very serious yet very controllable illness. In acute exacerbations, bronchospasm can be reversed with nebulized albuterol (2.5 to 5 mg); give 2 additional treatments at 20-minute intervals and then every hour for the first few hours until wheezing resolves. Subcutaneous terbutaline and epinephrine are alternatives. Systemic corticosteroids may be needed to manage the acute attack (eg, 2 mg/kg of oral prednisone or pred-nisolone). In addition, an anticholinergic agent (eg, inhaled ipratropium) may be used. IV magnesium (25 to 50 mg/kg) and heliox have shown promising results in acute asthma. Maintenance therapy is indicated when daily symptoms occur more than twice per week or when nighttime symptoms occur more than twice per month; such therapy may also be warranted for an infant with exacerbations that occur less than 6 weeks apart or more than 3 times per year, or when other risk factors are present. Inhaled corticosteroids are the cornerstone of maintenance therapy and are mandatory for all patients with persistent asthma. Alternative treatments for children younger than 5 years include cromolyn and an oral leukotriene modifier (montelukast). Patient and parent education helps ensure proper drug administration, monitoring, and compliance.
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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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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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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.
