Authors
Latest:
Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
Latest:
Ménétrier DiseaseA previously healthy 16-month-old boy was hospitalized because of vomiting of 10 days' duration, fever of 4 days' duration (temperature up to 38.6°C [101.4°F]), and watery diarrhea. He also had had a maculopapular rash, which resolved the day before presentation. Family history was unremarkable.
Latest:
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.
Latest:
Staphylococcal Scalded Skin Syndrome in a 5-Year-Old BoyA 5-year-old boy was brought to the emergency department by his parents because of a rash that covered his entire body. The rash had started 2 days earlier, initially on the boy’s face, abdomen, and legs and had spread to his back, buttocks, and hands. There was a 1-day history of tactile fever when the child was sent home from school. He had no sick contacts and his immunizations were up-to-date. He had no significant medical history.
Latest:
Adenoviral Hepatitis in an Immunocompetent ChildAdenovirus infection is usually benign in healthy children, but it can be complicated by severe or fatal pneumonia, myocarditis, and hepatitis. Consider adenovirus infection in children with fulminant hepatic failure.
Latest:
Consultations & Comments: Do You Recognize This Lesion?Consultations & Comments: Do You Recognize This Lesion?
Latest:
Folk Remedy as a Cause of Septicemia in a Child With LeukemiaA 15-year-old Hispanic boy with refractory T-cell acute lymphoid leukemia was hospitalized because of fever and pain and swelling of the right knee of 3 days' duration. The patient was taking nelarabine for a recurrence of his leukemia, which was diagnosed a year earlier. He appeared nontoxic. His temperature was 39.28C (102.68F). Other vital signs were within normal limits. The right knee was warm and tender, with mild restriction of movement.
Latest:
Case In Point: Subconjunctival Hemorrhages in a Teenage BoyA 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.
Latest:
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.
Latest:
May-Thurner SyndromeA 14-year-old girl with systemic lupus erythematosus (SLE) was evaluated for worsening left leg pain of 1 week’s duration. A month earlier, she had presented with left knee arthritis and a vasculitic rash; the antinuclear antibody titer was positive. In addition, she had leukopenia, myositis, hypocomplementemia, and mild proteinuria.
Latest:
Perianal Finding--Sexual Abuse or Normal Variant?A 23-month-old girl was brought to the pediatrician's office by her mother who was concerned about "bulging down there." The child's mother reported that a "bump" had been present in the girl's diaper area since her birth and that it had been growing.
Latest:
Podcast: Addressing Parents’ Concerns About Vaccinating Boys Against HPV InfectionYou and your colleagues are undoubtedly hearing questions from a lot of concerned parents about the new guidelines for vaccinating young boys against HPV infection. What are the chief concerns-and how can you best address those concerns?
Latest:
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.
Latest:
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 Girl With “Bumpy” Red EyeFive-year-old girl with redness and light sensitivity of the right eye of 2 days' duration. She denied any significant pain or decreased vision. She initially presented to an urgent care clinic, where application of polymyxin B/trimethoprim eye drops 4 times a day was prescribed.
Latest:
PompholyxFor 3 days, a 10-year-old boy had an itchy, tense, vesicular rash on the fingers of both hands (A). He was otherwise healthy.
Latest:
Henoch-Schönlein Purpura and Nonpitting EdemaA 10-year-old girl has had a worsening rash for 1 week. The mildly pruritic, nontender eruption initially appeared on the child's thighs and then spread to the arms and face. The child's right hand, feet, and ankles have been swollen for the past 4 days, which has made ambulation intermittently painful.
Latest:
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).
Latest:
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.
Latest:
Case in Point: Thyroglossal Duct CystA 9-year-old Hispanic boy presented with submental swelling and dysphagia. The swelling had progressed over 5 days. He had no history of fever, difficulty in breathing, or voice change.
Latest:
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.
Latest:
Photoclinic: Actinomycosis in a Young BoyA 9-year-old Hispanic boy, previously in good health, was admitted for evaluation of chronic right cervical adenopathy. The node had been present for about 6 weeks. The patient was initially taken to his primary medical doctor and given dicloxacillin, but there was no improvement. The patient reported no fever, sore throat, travel history, or animal exposure. He and his parents denied contact with any persons with tuberculosis. During the past year, the patient had undergone extensive dental work for excessive caries.
Latest:
Infant With Multiple Hepatic MassesA 2-month-old girl who lost 30 g over 7 days is noted to have multiple hepatic masses during abdominal ultrasonography to rule out pyloric stenosis; she is referred for further evaluation. She has a history of physiological jaundice and gastroesophageal reflux (GER). She continues to vomit despite treatment with ranitidine.
Latest:
Pediatric Chest Pain: Keys to the DiagnosisChest pain in children evokes anxiety in patients and their parents--and prompts frequent visits to the pediatrician's office, urgent care facility, or emergency department (ED). In a prospective study, Selbst and colleagues reported that chest pain accounted for 6 in 1000 visits to an urban pediatric ED.
Latest:
Risky Business, Part 2: Communicating Medical Risks to Patients and ParentsPracticing pediatricians commonlytalk with patients and parentsabout medical risks. Examples of suchrisks include those of a newborn havinga genetic disease, of a complication of anillness developing, and of a patient experiencingan adverse effect from a medicationor vaccine. Different ways of expressingand communicating risk mayhelp patients and parents understand themagnitude of a risk and make informed,thoughtful decisions about their medicalcare. It is important to be aware of theinfluence personal experience and concernshave on how risk is perceived andto recognize how the choice of a particularway of framing a risk may inadvertentlycommunicate a clinician's personalbiases in a situation.
Latest:
Fatal Case of Juvenile HemochromatosisA 16-year-old girl presented to the emergency department (ED) with an anaphylactic reaction to a bee sting on the right side of her neck. Within 15 minutes of her arrival, swelling, numbness, and pain developed at this site. She also had headache, shortness of breath, and vague abdominal pain associated with nausea.
Latest:
Acute Hemorrhagic Edema of Infancy in an 11-Month-Old GirlFor 2 days, an 11-month-old girl had a progressively worsening rash and subjective fever (A). The rash began on the legs as bumps, which later became large violaceous lesions (B) and spread to the face, arms, and trunk.
Latest:
Abdominal Mass in Teenage Girl: Hair's the DiagnosisA 14-year-old girl had fatigue, a slight sore throat, and low-grade fever for a week. The mother was concerned that she had “mono” like her older sister who had the same symptoms and in whom the illness was diagnosed 2 months earlier.
Latest:
Hot Tub Folliculitis in an 11-Year-Old BoyAn 11-year-old boy presented for evaluation of an itchy rash that developed during a ski vacation.
Latest:
Winter 1979This happened over 25 years ago, but she remembers it clearly. . . . at the time, she was a pregnant intern on the infant-toddler ward of the busiest children's hospital in the Midwest. It was December, and the ward was jumping. One of her patients, Tony, a 3-month-old with tracheomalacia and severe croup was sick and not improving much. Tony's mother was worried mainly about her son, but there were other things. She had recently come north after being laid off in Alabama. Her unemployment had quickly led to homelessness. She had a brother in town, and she had moved in with him. When she arrived, she found out that he was a heroin addict. He was uninterested in her and her son, and his house was unsafe.
