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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.
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Winter Sports Injuries: Patterns of Injury--Preventive MeasuresMillions enjoy skiing, snowboarding, and sledding. These cold weather activities--while exhilarating--also cause many injuries, each with distinct clinical characteristics.
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Newborn With Urinary DysfunctionDuring circumcision, a newborn is noted to have continuous dribbling of urine from his meatus and stool from his anus. After several minutes of observation, the urinary stream appears weak and remains a constant trickle. The baby boy was born at term via an uncomplicated spontaneous vaginal delivery.
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Pediatric ECGs: A Primary Care PrimerPediatric ECGs are regularly performed for a variety of conditions, including chest pain, syncope, and suspected arrhythmia. Correct interpretation of ECGs can be challenging when technique is faulty or when the variability of normal values in children is not taken into account.
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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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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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6-Year-Old Girl With Marks on NeckAn almost 7-year-old girl was referred to Child Protective Services for evaluation of suspected sexual abuse after a school nurse noticed marks on her neck (Figure). The nurse was concerned that the marks were "hickeys," or suction marks, made by another person's mouth.
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Crime and Therapy: Good News About Pharmacotherapy for ADHDSome criminal activity can be eliminated by pharmacotherapy for ADHD. Should this information influence clinical practice? The short answer is an unequivocal yes.
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Apert Syndrome in an InfantAfrican American girl born at 36 weeks' gestation to 24-year-old primigravida via spontaneous vaginal delivery at a community hospital. Apgar scores, 7 at 1 minute and 9 at 5 minutes. Grossly normal placenta, with a 3-vessel cord. On the second day of life, infant required several minutes of blow-by oxygen for a desaturation event and subsequent transfer to a level III neonatal ICU for further monitoring.
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Ranulas in a 14-Year-Old Boy14-Year-old boy who presents to emergency department with nonpainful swelling under his chin that began about a week earlier. Swelling has been gradually growing; patient now has some difficulty in flexing his neck.
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Post-Concussion Syndrome in Young Female Soccer PlayersYoung female athletes are vulnerable to concussions and other sports-related head and neck injuries. Repeated insult may lead to permanent neurologic deficit.
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Diabetes Q&A: 70/30; "Rule of Fifths"; Split-Mix; Basal-Bolus-- Which Is Best?During my training, most pediatric endocrinologists were using the "70/30 rule" or the "rule of fifths" to determine the insulin dosage for patients with new-onset diabetes. Now that I am in practice, I have heard that carbohydrate counting is a more accurate method of determining a child's insulin needs.
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Axenfeld Nerve LoopA 12-year-old girl was brought by her parents for evaluation of a spot in her eye, which they feared might be an embedded foreign body. She had nominal eye discomfort, which was probably secondary to attempted removal of the object. The child could not recall having dust particles in the eye, and she had no previous eye lesion.
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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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Photoclinic: Mycoplasma InfectionA scaly, erysipeloid rash had erupted in the axillae of an 8-year-old boy and spread to the buttocks and thighs within 2 days. The child complained only of pruritus. The rash had worsened despite treatment with clindamycin for 4 days.
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A Wormian Bone in a NeonateWormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.
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A Toddler Intolerant of Tube FeedingA 22-month-old boy with failure to thrive presented with a 3-day history of rhinorrhea, fever, and abdominal pain associated with tube feeding. A PEG tube had been placed 2 months before this visit.
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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.
