Allergy, Immunology, and ENT

A 7-week-old white boy presented to the emergency department (ED) with vomiting and weight loss. His parents brought him to the ED 3 weeks earlier after he had vomited for several days. Possible milk protein allergy was diagnosed at that visit, and a change from cow milk formula to an elemental formula was recommended. Vomiting subsequently increased in frequency. Nonbilious but forceful vomiting occurred with each feeding. The patient lost nearly 2 lb during the 3 weeks that followed the first ED visit.

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A 2-year-old boy was brought for evaluation of a rash and fever of 2 days' duration. He had atopic dermatitis since 6 months of age that was partially controlled with low-potency topical corticosteroids and emollients. His father reported that recently the facial dermatitis had worsened, with increased redness, pain, and some skin breakdown. The child's medical history was otherwise unremarkable. His mother had a history of "cold sores."

This adolescent girl presents with painful purple papules that have developed on her toes. These papules are making it impossible for her to wear her "fashion" shoes to school in the late fall and early winter. She reports that her feet have been cold for as long as she can remember and that she is not bothered by it. She is otherwise healthy, takes no medications, and does not smoke.

ABSTRACT: Children are at greater risk than adults for many travel-related problems, such as barotitis and barotrauma associated with flying, cold and heat injury, drowning, and infection with geohelminths. Most of these problems can be avoided with appropriate measures. To prevent insect-borne diseases, advise parents to apply permethrin to their children's clothing before the trip and apply slow-release DEET (30% to 35% concentration) to their skin every 24 hours. Infection with ground-dwelling parasites can be avoided by wearing protective footwear. At high altitudes, infants and children may experience acute mountain sickness. Acetozolamide (5 mg/kg/d, divided bid or tid) is an effective prophylactic; however, it is contraindicated in patients with sulfa allergy. Some preventive measures that are effective in adults may not be appropriate for children; for example, several medications used to control motion sickness are ineffective and associated with significant side effects in children.

An 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.