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African 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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14-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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Young 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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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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A 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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The 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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A 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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Wormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.

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A 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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Timothy 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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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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For 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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A 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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An 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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The 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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Twenty-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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Five 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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A10-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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Baby 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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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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The 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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The 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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A 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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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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Adenovirus 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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One 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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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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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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It 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.