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Home Alone: At What Age Are Children Ready?I’d like to increase my hours at my job from part-time to full-time when my son starts middle school. He’d be home by himself for an hour and a half between the end of his afterschool program and the time I’d be back from work. Do you think he’s old enough to be home alone for that time?
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White Patches on a Young Boy's TrunkA 3-year-old boy with white patches on the trunk first noticed shortly after birth.
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That’s Not My Child: A Case of Capgras SyndromeMary, aged 40 years, was referred for psychiatric evaluation out of concern that a mental health diagnosis was interfering with her ability to appropriately and safely care for her child. The patient had stated on numerous occasions that her 9-year-old daughter, had been placed in the custody of Child Protective Services and replaced by an imposter.
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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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Flank Pain, Decreased Urine Output in Young BoyA 10-year-old boy presents to your office with sharp right-sided flank pain. The pain began the night before, and the child could produce only a few drops of urine the next morning.
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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.
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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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Influenza Vaccine for Egg-Allergic Patients-Safe?My 18-month-old son has had a diaper rash, with no other symptoms, within a few days of eating a poached egg on 3 separate occasions.
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What Caused This Breast Lump?A 16-year-old girl has had a left breast lump for 6 months that recently became tender. Except for several small nodules in both breasts and tenderness of the lateral left breast, physical findings are normal and the patient is otherwise healthy.
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Fish Tapeworm InfestationA 15-year-old boy presented with a “string” protruding about 5 cm from his anus. He had had abdominal cramping that morning, prompting a bowel movement. After the stool, he passed a meter-long object that broke into the toilet. He attempted to remove the remaining “string,” but pulling on it induced left lower quadrant abdominal pain. He denied purposefully ingesting nonfood objects, choking, or chewing anything unusual. He also denied inserting anything or having anything inserted into his anus. He was otherwise healthy and had no significant medical or family history.
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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.
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Baby Boy Cries With One Eye OpenThis 1-week-old baby boy was brought for his first newborn visit. The parents were concerned that when he cried, the left side of his face “does not move.”
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Persistent Ankle Mass in an Otherwise Healthy 9-Year-Old GirlAn apparently healthy 9-year-old girl noted to have left ankle mass during well-child checkup. Her last well-child visit was 3 years earlier. Medical history unremarkable. She denied fevers, weight loss, night sweats, and chills. No family history of bone deformities or growth disturbances.
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ADHD and the Adolescent Driver:ABSTRACT: Adolescent drivers with attention deficit hyperactivity disorder (ADHD) are more likely to be involved in--and to die of--a driving accident than any other cause. The higher occurrence of driving mishaps is not surprising given that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity. Safe driving habits can diminish the risk, however. The first step is to inform patients of the dangers of driving; the significance of adolescence, ADHD, and medication can be underscored in a written "agreement." Strategies to promote safer driving--especially optimally dosed long-acting stimulant medication taken 7 days a week--may be critical. A number of measures lead to safer driving by reducing potential distractions during driving (eg, setting the car radio before driving, no drinking or eating or cell phone use while driving, no teenage passengers in the car for the first 6 months of driving, and restricted night driving).
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Fractures From Short Falls: Implications in Children Under Age 5Primary care and emergency physicians frequently see young children who have fractured a bone after a fall from a low height. The child's caregiver may describe a fall from furniture, play equipment, stairs, and various other structures--or the child may have even been dropped while being carried. The clinician then has to decide whether the explanation for the fall is plausible--or whether a child abuse investigation should be pursued.
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Allergic Reaction to Nickel in Swallowed CoinsAn 8-year-old boy seen at a gastroenterology clinic after "accidentally" swallowing 2 coins 4 days earlier. Had difficulty in breathing shortly after swallowing the coins and was taken to emergency department. X-ray films at that time demonstrated coins in his esophagus. Patient was immediately transferred to a tertiary care facility. Repeated x-rays showed the coins in his stomach. Patient was sent home with instructions to follow up with his pediatrician in 1 to 2 days.
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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 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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ADHD: A Guide to Assessment and DiagnosisAttention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed bio-behavioral disorder of childhood. It occurs in 6% to 9% of children--about the same prevalence as childhood asthma. It is also one of the most controversial diagnoses in children; parents are often perplexed about whether ADHD is underdiagnosed or overdiagnosed, or undertreated or overtreated. A good deal of this confusion stems from the fact that there are no laboratory tests, imaging studies, or psychological testing profiles that can be used to make the diagnosis.
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Infant With Recurrent Omphalitis and OtitisA baby boy, aged 14 days, presented with a temperature of 38.2°C (100.8°F), a generalized maculopapular rash, and purulent otorrhea. He was treated with oral amoxicillin for 10 days. At age 25 days, he again presented-this time with erythema and edema of the umbilicus, thrush, and fever of 24 hours’ duration.
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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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Photoclinic: Systemic Allergic Reaction to Embedded Sewing NeedleA thriving boy was brought to the office 3 weeks after his first birthday. His mother reported that there was "something wrong with his knee." On visual examination, the knee appeared perfectly normal. On palpation, however, a 4-cm linear induration was evident over the knee fat pad, just medial and distal to the patella. It appeared soft, crepitant, and associated with the skin. No tenderness was noted on palpation; the infant did not object to palpation of this density any more than to auscultation, otoscopy, or anthropometric measurements. No erythema, ecchymosis, or signs of trauma were evident near the lesion. The only possibly relevant history was that the child had spent his birthday at his grandmother's home in the Ukraine a month earlier. He was constantly with his mother during that time, and no trauma was ever reported.
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Photoclinic: Swallowed BeadsThe patient is an 8-year-old girl with a history of asthma and developmental delay. She complained of hip pain, and her pediatrician referred her to a pediatric orthopedist for consultation. Hip x-ray films were ordered; they revealed 3 round beads in the child's appendix.
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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.
