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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.
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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
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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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Flat Warts and SyringomasThis girl was brought for evaluation of these "bumps" around her eyes. Her parents are concerned that the lesions will interfere with her vision.
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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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Child With Unusual Appearance, Inguinal Hernia, Accelerated Growth, and Developmental DelayA 10-month old white child was admitted for evaluation of an enlarged abdomen, splenomegaly, and developmental delay. The child had a normal gestation and birth weight. He had a right hydrocele at birth and rapid scrotal enlargement at age 3 months that led to repair of a right inguinal hernia.
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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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Eczema Herpeticum With MRSA SuperinfectionA 7-month-old boy with a history of severe atopic dermatitis and asthma was brought for evaluation of a generalized rash, fever, and irritability of 2 days’ duration. He had no respiratory symptoms. His medical history was significant for anorexia, without vomiting or diarrhea. He had a strong family history of allergy.
