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“Replacing Pills With Skills” Workshop Teaches Self-Care Techniques for KidsTimothy Culbert, MD, and Rebecca Kajander, MPH, CNP, nearly put the audience to sleep at their October 18th interactive workshop, “Replacing Pills with Skills.” But that was just what they had hoped would happen!The two staff members from the Integrative Medicine Program at Children’s Hospital and Clinics in Minneapolis demonstrated-and then had the audience practice-a variety of self-care techniques that can be taught to children to help them manage common health problems, such as pain, insomnia, anxiety, and nausea.
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Politics and the HPV Vaccine: How Would You Respond?Minnesota Congresswoman Michelle Bachmann recently caught the attention of a lot of people when, during a television interview following a Presidential debate, she claimed that the HPV vaccine has “very significant consequences.”
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Henoch-Schönlein purpura with gastric wall thickeningFor 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
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Child With "Burns" on the TongueA healthy 4-year-old girl presented to the emergency department (ED) with suspected inflicted burns on the tongue. Initially, the patient had complained of a burning mouth to school staff. On direct questioning by the principal, the child said her mother had burned her tongue with a cigarette. School staff noted the lesions.
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Papular Perianal Rash in an 8-Year-Old GirlAn 8-year-old girl is brought to the emergency department by her mother with a complaint of 5 days of worsening constipation and rectal bleeding. For the past week, the girl has had small stools 3 or 4 times a day and crampy abdominal pain. Yesterday, her stools were streaked with a small amount of blood. The mother notes that her daughter spends up to an hour in the bathroom with each bowel movement. In addition, the mother remarks that the girl has a rash in the rectal area and along the inner thighs.
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Photoclinic: SchizencephalyThe adoptive parents of an 11-month-old infant noticed that their son did not use his right arm as often as the left. Concern for brachial plexus injury was raised. Antenatal, natal, family, and early developmental history were unknown.
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Atypical Tuberculin Skin Test ResponsesTwenty-four hours after receiving a standard 5-unit purified protein derivative of tuberculin (PPD) skin test, a young African American presented with a slightly pink, raised, firm plaque at the site of the injection (A). His previous PPD test results were negative. He denied any constitutional symptoms and rashes. He was otherwise healthy, was not taking any medication, and was HIV-negative.
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Botfly InfestationFive weeks after returning from a school trip to the Amazon in Peru, a 16-year-old boy presentedwith 2 persistent “bug bites” on the lateral left calf. He had sustained multiple bug bites duringhis trip, all of which had resolved spontaneously except for the 2 on his lower leg.
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TrichotillomaniaA10-year-old boy was brought to a medical mission clinic in Roaring Creek, Belize, for evaluation of bald spots on his head. The mother reported that the bald areas seemed to be worsening because of the child's uncontrollable desire to pull out his hair.
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Newborn With Abdominal Mass and DistentionBaby girl born at 37 weeks’ gestation to a gravida 2 para 1, 25-year-old mother by spontaneous vaginal delivery. Apgar scores, 8 at both 1 and 5 minutes. Placenta grossly normal with a 3-vessel cord. Prenatal course uncomplicated. Mother’s blood type, A-positive. Results of prenatal testing negative for hepatitis, syphilis, rubella, group B streptococcal disease, and HIV infection. No significant maternal or family history.
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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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Ectoparasite Bites from a KittenThe morphology and distribution of these lesions is characteristic of ectoparasite bites, which occur when a human carries a pet-usually a kitten or puppy-as if the animal were a human newborn baby.
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Photoclinic: Symmetric Ankle BruisesThe mother of this 5-month-old infant was concerned about the lesions that appeared on her son's inner ankles after he had spent the day with his babysitter. The lesions had not been present when the child was dropped off earlier that morning. His grandmother feared they might be cigarette burns.
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Case in Point: An Unusual Injury to the MouthA 2-year-old boy was brought to the emergency department by his mother after he slipped and fell in the bathtub. The boy's father, who had been bathing the child when the injury occurred, reported that he had briefly turned his back while the child was attempting to drink from the hook-shaped faucet. The child had jerked his head upward when he fell, thus causing the sharp edge of the faucet tip to lodge in the soft floor of the mouth beneath the tongue. The father, in desperation, wrenched the faucet from its base and then was able to remove the tip from the child's mouth. During the removal process, the child reached up and also cut his finger on the sharp edge of the faucet.
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Did a Vaccine Cause this Disease?Active, healthy 11-y/o boy develops degenerative neurologic symptoms. PMH relevant for measles at age 1 year, MMR vaccine at 8 months. Is there a connection?
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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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Eczema HerpeticumOne week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent. She was afebrile. Worsening eczema with secondary infection was diagnosed. Treatment with oral clindamycin was prescribed. At follow-up, the lesions had worsened. The child had multiple excoriated papules, some of which had coalesced into plaques. She also had two 5-mm vesicles on her right shoulder. Eczema herpeticum was diagnosed clinically. Culture of the vesicles later grew herpes simplex virus (HSV).
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A Young Girl With Unexplained Cervical Lymphadenopathy: Infection? Lymphoma--or Something Else?An 11-year-old African American girl was hospitalized with new fever in the context of unexplained cervical chain lymphadenopathy. WBC and ANC were low, ESR and LDH levels were elevated. Does the image here offer a clue to the ultimate diagnosis?
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Pediatric Vasculitic Syndromes:A 7-year-old boy presented to his primary care pediatrician with a 24-hour history of vomiting, abdominal pain, and low-grade fever. The child appeared stable. A viral illness was diagnosed. The child was sent home, and his parents were advised to give him adequate fluids as well as acetaminophen as needed for fever.
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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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5-Month-Old Girl With Left Facial Droop of Sudden OnsetA 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies.
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Dog Bite in a Penicillin-Allergic PatientThe patient, a 14-year-old boy, comes to see you the same day he was bitten by a dog. In the examination room, you find him seated comfortably in the chair with his right hand and arm bandaged.
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Photoclinic: Arachnoid CystThe parents of a 7-year-old girl, who had fallen off her bicycle and hit her left forehead 2 weeks earlier, brought their daughter to the emergency department after she began having increasingly severe headaches. She had been healthy before her fall and had no history of other trauma or meningitis. She had no neurologic deficits on presentation. Examination of the fundus revealed no papilledema.
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Asthma Therapy Complicated by Peters Plus SyndromeThe authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis.
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Omental Cyst Presenting as Acute AbdomenA 2-year-old girl was transferred to the pediatric ICU from a nearby community hospital because of nonremitting, generalized abdominal pain associated with fever and vomiting. Her symptoms had begun 3 days earlier and had progressively worsened despite treatment with antibiotics, pain medication, and fluids.
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Photoclinic: Varicella-Zoster InfectionA 9-year-old girl was hospitalized because of a painful, vesicular rash on her genitals, groin, and buttocks. There was also concern about possible genital herpes infection in a minor.
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Polycystic Ovary SyndromeA 13-year-old girl presented to her primary care pediatrician for continuing evaluation of intermittent right lower quadrant and right hip pain of 7 months' duration. As part of the workup, a pediatric orthopedist had ordered an MRI scan of her pelvis. The findings were normal except for the presence of multiple ovarian follicles bilaterally (Figures 1 and 2).
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Photoclinic: Winged ScapulaA 14-year-old girl presented with concerns about a "deformed" right shoulder. Despite the fact that there was no associated weakness, the defect made her self-conscious. She denied recent trauma to the site and severe physical exertion.
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Young Boy With Different Colored EyesA 6-month-old boy with different colored eyes since birth. The parents are concerned that the eye anomaly may be associated with an underlying condition after reading about eye disorders online.
