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Case in Point: Sandifer SyndromeA previously healthy full-term, 30-week- old infant presents to the emergency department after a 30-minute episode in which he turned blue after a feeding. His mother states that the infant was also stiff, that he "arched his back," and that his eyes "had a blank look." There was no twitching associated with this episode, and the infant had no fever, cold symptoms, or any sick contact.
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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.
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Cystic Hygroma in a 1-Year-Old GirlThe parents of this 1-year-old girl brought her for evaluation of a neck mass of sudden onset (A). They had first noticed the mass on the morning of presentation. The child had cold symptoms and had been snoring, but she had no history of fever, shortness of breath, wheezing, or stridor. Her activity level and appetite had not changed.
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Wilson Disease in a Teenagerhe parents of a 16-year-old girl report that during the past several months, she has exhibited behavioral changes, irritability, increased anger, depression, and anxiety. The girl had previously been healthy, and there has been no recent illness or trauma.
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Toddler With Chest Pain, Trouble Breathing, Cough After Heart SurgeryA 3-year-old boy with chest pain and trouble breathing that had developed over the past 24 hours was brought to the emergency department. The parents reported that his most prominent symptom was a cough. The chest pain appeared to worsen with coughing. He had undergone open atrial septal defect repair about 3 weeks before presentation.
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What Rx Findings Reveal About Teenage Boy’s Elbow PainA 15-year-old boy presents with pain in the medial aspect of his right elbow that began 4 to 6 weeks earlier and progressively worsened.
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Secondary Syphilis Palmar LesionsThe patient denied use of new skin products, detergents, or medications. He had no pets. There was no history of recent travel, and the patient was not aware of any arthropod bites. None of his family members had a similar rash. The patient was sexually active and had had 3 partners in the past 2 years; he said he always used condoms. His history was otherwise unremarkable, as were physical findings.
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Cellulitis-Adenitis From Late-Onset Group B Streptococcus InfectionA 2-month-old infant had right submandibular swelling with inflammation and induration up to the nape of neck. Ultrasonography showed multiple enlarged lymph nodes with soft tissue swelling. Blood cultures grew Gram-positive cocci, which were identified as group B streptococci. Late-onset GBS infection is acquired from colonized household contacts.
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Michelin Tire Baby SyndromeThese circumferential symmetric skin creases are called the “Michelin Tire baby syndrome” because of their striking resemblance to the mascot of the French tire manufacturer.
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Concussion in Young Athletes: Heads Up on Diagnosis and ManagementThe increased incidence of sports-related concussion reported nationwide has attracted much media and public attention. Most data about sports-related concussion involve professional, college, and high school level athletes
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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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Case in Point: Acute Osteomyelitis: Radiographs Versus MRIA 10-year-old boy with no medical history was brought to his pediatrician's office with a 2-day history of intermittent fever (temperature of 38.8°C to 39.4°C [102°F to 103°F]). Physical examination results were unremarkable. There was no history of recent trauma. The child was sent home with analgesic therapy.
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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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Cystic Hygroma in an Infant GirlUltrasonography showed a large multiseptated cystic mass in the posterior part of the left side of the neck. No obvious vascular flow evident within the mass (Figures 3 and 4).
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Child With Bullous Lesion on Left Side of GroinA 16-month-old Hispanic girl presented with a 2-day history of pain, redness, and swelling of the left side of her groin. Her mother first noticed the lesion after the child was seen limping and scratching the area. The mother thought her child had been bitten by an insect but did not witness any bite.
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Pediatric Musculoskeletal Infections: Managing the Significant OrganismsMusculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial.
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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.
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Ataxia-TelangiectasiaAtaxia-telangiectasia is an autosomal recessive condition characterized by progressive cerebellar ataxia and oculocutaneous telangiectasias.
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Photo Essay: Hyperpigmented MaculesThis 13-year-old boy has a Becker nevus--also called Becker melanosis, because the lesions do not contain nevus cells. This common lesion is characterized by the abrupt onset of hyperpigmentation that gradually expands; it appears at or before adolescence.
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A Young Boy With Painful, Erythematous Nodules on Lower ExtremitiesA 5-year old boy presented with these nonpruritic nonsuppurative painful erythematous nodules on his lower extremities. The rash had appeared about 1 week after the onset of a dry hacking cough.
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Boy With Extraordinarily High Blood Lead LevelsA 9-year-old asymptomatic boy was referred to our tertiary care facility with a blood lead level (BLL) of 59 ?g/dL. A diagnosis of attention deficit hyperactivity disorder, which was managed with amphetamine/dextroamphetamine, had been made when the patient was 6 years old.
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An Overview of Chronic Cough in ChildrenHere: an overview of the pathophysiology of chronic cough, its epidemiology and etiology; the clinical evaluation, diagnostic workup, and a summary of treatment options.
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Toddler With Decreased Appetite and ActivityAn 18-month-old white boy is brought to his well-care visit by his parents, who are concerned that for the past month he has been less social and active. He has appeared weak and has refused to walk or play with his siblings. He has also had a decreased appetite and has lost about 2 kg. He has vomited several times but with no bile or blood.
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Nasal Allergy and Sinus Infection: The Link--and Therapeutic ImplicationsThe prevalence and incidence of sinus infection, or sinusitis, is increasing and has been estimated to affect 31 million persons in the United States each year. It is one of the most common reasons why patients seek a physician's care. If left untreated, sinusitis can cause significant physical symptoms and can negatively affect quality of life by substantially impairing the daily functioning of sufferers. For children, this can mean learning difficulties at school and for adults, a loss of efficiency at work.
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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.
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Acute Lymphoblastic Leukemia Presenting as Soft Tissue MassFor 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.
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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.
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Anxiety Disorders in Children: Common-But Often MissedThe American Academy ofChild and Adolescent Psychiatry recommendsroutine screening for anxiety inchildhood, querying various sources (child,parent, teacher) about anxiety symptoms,assessing for comorbid disorders,and evaluating severity and functionalimpairment. Transient and developmentallyappropriate worries and fears need tobe distinguished from anxiety disorders.Somatic symptoms, such as headache orstomachache, often accompany anxiety.A child’s anxiety may manifest as crying,irritability, or other behaviors that maybe misunderstood by adults as disobedience.Self-report measures can helpscreen for anxiety symptoms and monitortreatment response. Psychotherapy isthe initial treatment of children withanxiety. Pharmacotherapy with selectiveserotonin reuptake inhibitors may benecessary for those with moderate tosevere anxiety. In these children, theaddition of cognitive-behavioral therapymay improve functioning better thaneither intervention alone.
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Unusual Lesions-Abuse or Accidental Injury?Because of the presence of unusual skin findings, a 3-year-old African American girl was evaluated for possible child abuse. The father, the primary guardian, reported that his daughter had returned home from her mother's residence 2 days before-a day earlier than planned. According to the father, the child was crying and had skin lesions, which initially appeared white and then darkened over the course of the next day or two.
