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Photoclinic: Vaccine-Induced Herpes ZosterIn the Photoclinic item titled "Vaccine-Induced Herpes Zoster," by Julie L. Cantatore-Francis, MD, and Yelva Lynfield, MD (Consultant For Pediatricians, June 2005, pages 290 and 291), the dosage of acyclovir was incorrectly printed as 80 mg/d divided into 4 doses. The correct dosage is 80 mg/kg/d divided into 4 doses. We apologize for the error.
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What Are Common Comorbidities in ADHD?In this expert Q&A, Julie Sherman, PhD and Jay Tarnow, MD briefly discuss the latest research findings on ADHD.
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Tinea FacieiA 7-year-old boy was brought for evaluation of a rash on the chin that had appeared 2 weeks earlier. It was slightly itchy. The mother had applied a topical corticosteroid for a few days but then stopped because of worsening of the lesion.
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Acute Poisoning: Keys to Zeroing In on the CausePoisons have been a threat to the health and well-being of humankind for millennia. Given the ubiquitous nature of potential poisons, exposure to a toxin should be included in the differential diagnosis of patients with unexplained illnesses or unusual presentations.
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Cystic Hygroma in an 11-Year-Old GirlAn 11-year-old girl presented with a swelling on the left side of the chin of 1 month's duration; in the past 24 hours, following a bite by an unidentified insect, the swelling had rapidly enlarged and become painful (A). She was otherwise healthy and had no significant medical or family history.
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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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Wiskott-Aldrich SyndromeThis 9–month–old boy was initially evaluated at age 6 weeks for an extensive eczematous rash on the head and antecubital and diaper areas and blood and mucus in the stool with each diaper change over a 2– to 3–week period. The symptoms were attributed to milk allergy, and the infant’s formula was changed. At 8 weeks of age, a petechial rash developed on the boy’s trunk and legs. His symptoms persisted despite multiple formula changes, and he was referred to the emergency department.
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Two-Year-Old Boy With Recalcitrant “Diaper Rash”A 2-year-old boy brought for pediatric dermatology consultation because of the "worst diaper rash in the world." Mother reported that the rash had been present for a year and was asymptomatic. She had been using topical barrier creams, corticosteroids, and antifungals to treat the area. Child had also received a course of oral antibiotics. Occasional improvement of rash noted but never complete resolution. Patient had no other medical problems. Family history noncontributory.
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Ganglion cystThe bump on this 5-year-old girl's left wrist had been gradually enlarging. The child could not remember how long it had been present.
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Case in Point: Night TerrorsThe patient is a healthy 5-year-old boy who typically awakens 90 minutes after falling asleep. His parents find him screaming, sweaty, and standing up wide-eyed in bed (Figure A). These episodes occur 3 or 4 times a week. He is otherwise a happy, well-adjusted child who attends kindergarten. He has an older sibling with whom he gets along well. There have been no changes in the family.
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The Uncontrollable Child: Family and Educational InterventionsIt is estimated that about 20% of children and adolescents meet criteria for a mental health disorder, and a high percentage of these youths are impaired by disruptive behavior problems.
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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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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.
