Authors
Latest:
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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Meningococcal Immunization Update: A New Conjugate VaccineWith the significant decline in disease caused by Haemophilus influenzae type b and Streptococcus pneumoniae achieved through vaccination, Neisseria meningitidis has moved to the forefront. Its emergence as the most important cause of bacterial meningitis challenges the pediatrician to prevent and control this terrible disease. Meningococcal disease can be easily misdiagnosed. It may present with different clinical manifestations, and its signs and symptoms may mimic those of common viral illnesses, such as influenza. The onset and progression of meningococcal disease are rapid. Although the rate of disease is highest in infants, morbidity and mortality rates for this disease are highest in adolescents and young adults, despite the existence of effective therapies.1
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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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Shin Guard DermatitisA 10-year-old boy had increasing irritation and itching of the lower legs for the past 5 weeks. The boy was an avid soccer player. Examination revealed an acutely inflamed, exudative dermatitis on the anterior aspect of both legs.
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Podcast: Controller Use in Children With AsthmaHere to discuss her observations about controller medication use and sleep problems in children with asthma is Michelle Garrison, MD.
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Foreign-Body Aspiration: A Guide to Early Detection, Optimal TherapyABSTRACT: Because foreign-body aspiration can cause symptoms that mimic those of other respiratory conditions, a high index of suspicion is crucial in all children who have pneumonia, atelectasis, or wheezing with an atypical course--especially when these conditions are unresponsive to usual medical therapy. A history of choking can usually be elicited in a patient who has aspirated a foreign body: such a history should be sought when respiratory symptoms develop suddenly. However, the absence of a choking history does not rule out foreign-body aspiration. Moreover, patients may be asymptomatic initially. Normal radiographic findings do not exclude an aspirated foreign body. Bronchoscopy should be strongly considered when an aspirated foreign body is suspected, even if radiographic images show normal findings. Rigid bronchoscopy is the procedure of choice for removing aspirated foreign bodies in children. Prevention of foreign-body aspiration can be enhanced through anticipatory guidance of parents/caregivers and through continued product safety efforts.
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Headache Secondary to Epidural AbscessTwo weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later. At that time, he had upper respiratory tract symptoms and a temperature of 39.4C (102.9F). CT scans of the head without contrast demonstrated pansinusitis with complete opacification of the frontal sinuses and frontal soft tissue swelling. The patient was admitted and given ampicillin/sulbactam intravenously for 3 days.
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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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Photoclinic: Atypical Juvenile DermatomyositisAn 8-year-old boy whose family had recently immigrated from Southeast Asia was brought to the emergency department (ED) with a well-demarcated, pruritic rash that had appeared on his face 6 weeks earlier. At that time, the patient's primary care physician had diagnosed Fifth disease. As the rash spread to the child's arms and back, atopic dermatitis was considered. The week before presentation in the ED, the rash had become more inflamed and pruritic and was accompanied by fevers.
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Ear Anomalies and Neck Sinuses in a NewbornA newborn male had "cup-shaped ears" and draining neck sinuses that were partially closed by age 3 months. At birth, the child weighed 8 lb 4 oz after a 39-week gestation that was complicated by a single abnormal diabetes screen.
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When to Consider Surgery for an Obese TeenMy daughter has been overweight her whole lifeand is always the largest kid in class. She’s juststarted high school and wants so badly to feelattractive, yet she cannot bear trying anotherweight loss program. At 5 ft 6 in, she weighs262 lb. Can you refer her to a surgeon so she canhave the operation that helps her lose weight?
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Nasal Congestion and Intermittent Fever in Girl With Transient Hypogammaglobulinemia of InfancyA 51⁄2 -year-old girl was brought to her pediatrician’s office by her mother, who reported that her daughter had a 1-week history of nasal congestion, intermittent fever, and cough that was worse in the morning and at night. The child was alert and smiling and appeared to be in no apparent distress.
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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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Herpes Zoster (Shingles) in a TeenagerSixteen-year-old with a recurrent, painful, pruritic rash on right cheek and right eyelid. Current outbreak started 2 days earlier. The rash always appears in the same fashion and in the same location; it typically lasts a few days and resolves spontaneously.
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Mandible Fracture After a Motor Vehicle AccidentA 4-year-old girl was brought to the emergency department after she sustained an injury to her jaw in a car accident. She had been restrained in the rear passenger seat with a seat belt. She had not lost consciousness and was not ejected from the vehicle.
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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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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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Neuroblastoma in a Child With Persistent Hip PainA 4-year-old boy presented for further evaluation of persistent right hip painof 2 months’ duration. Before the onset of the pain, he had been limping,favoring his right side. For several days before he was brought in forevaluation, he had had fevers and sweating in addition to the right hippain.
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Case In Point: Erythema Ab IgneA 14-year-old African American boy presented during the winter months with a painless, nonpruritic, periumbilical rash that had been present for approximately 1 month. Initially bluish, the rash had become dark brown.
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Lymphangioma Circumscriptum With Secondary CellulitisFor 3 days, a 6-year-old boy had “redness and pain” of skin on his left upper abdomen. Physical examination revealed a large cluster of vesicles with underlying erythema and mild warmth.
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Newborn Circumcision: The Gomco MethodHere: a "how to" on Gomco circumcision, the method most commonly used in the US.
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Headache Secondary to Epidural AbscessTwo weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later. At that time, he had upper respiratory tract symptoms and a temperature of 39.4C (102.9F). CT scans of the head without contrast demonstrated pansinusitis with complete opacification of the frontal sinuses and frontal soft tissue swelling. The patient was admitted and given ampicillin/sulbactam intravenously for 3 days.
Latest:
Young Child With Hematuria and DysuriaA 3-year-oldgirl is brought to the office because of a 1-week history of hematuria and dysuria. Her mother had noticed bright red blood in the child's urine and diaper. The child did not have dysuria initially but later complained of a burning sensation. A week earlier, the patient had been seen at an urgent care center. Oral trimethoprim/sulfamethoxazole was prescribed after urinalysis showed numerous red blood cells and few white blood cells. However, the hematuria persisted.
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Case In Point: Infant With Aldosterone DeficiencyA 45-day-old boy was referred for evaluation of persistent hyponatremia and hyperkalemia. On the 9th day of the boy's life, his serum potassium level was elevated (8 mEq/L) and on the 12th day, his serum sodium level was low (131 mEq/L). Supplementation with sodium chloride was initiated.
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Two Girls With Short StatureA 14-year-old white girl whose menstrual periods have not begun presents with concerns that many of her peers are already menstruating.
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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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Two Missed Cases of Abuse: Lessons LearnedA 7-month-old male infant was brought to the emergency department (ED) by his biological mother, who reported noticing dried blood on the baby's penis and in his mouth. For several hours prior, he had been in the care of her boyfriend. On physical examination, there were severe ecchymoses and petechiae on the penile glans and shaft (Figure 1), ecchymoses on the right side of the soft palate, a laceration of the lingular frenulum, and a 2-cm bruise with dried blood over the right lip.
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Photoclinic: Cutaneous Calcinosis in a Child With Tertiary HyperparathyroidismPhotoclinic: Cutaneous Calcinosis in a Child With Tertiary Hyperparathyroidism
