Consultant for Pediatricians Vol 4 No 9

ABSTRACT: Hypothermia is not limited to the northern states: people also die of hypothermia in other areas with milder climates. Infants, young adolescent boys, and inadequately dressed teens who abuse alcohol or illicit drugs are at highest risk for death secondary to hypothermia. The mildly hypothermic patient may appear fatigued and display persistent shivering, ataxia, clumsiness, confusion, tachypnea, and tachycardia. The child with moderate hypothermia will not be shivering; declining mental status may cause the freezing patient to remove clothing. An irregular heartbeat is likely at this stage. Severe hypothermia is marked by apnea, stupor, and coma. In a frostbitten patient, rapid rewarming of the affected area in warm water for 15 to 30 minutes is the first step. Potent analgesia is often necessary. After thawing, the frostbitten part is kept dry, warm, and loosely covered. With an adequate dose of common sense, the vast majority of deaths from cold injury can be prevented.

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."

In the aftermath of Hurricane Katrina's devastation in the Gulf Coast region, it is important for physicians in the United States to consider the infectious disease risks for children who have been displaced or who are still living in affected areas. These risks include infections acquired through ingestion of waterborne organisms; wound infections; lack of immunization continuity; and overcrowding, which increases the risk of respiratory or GI infections. In addition, problems will arise from disruption of therapy for select populations of children, such as those who are HIV-infected; those receiving immunosuppressive treatment; and those in need of continuous antibiotic prophylaxis, such as those who have sickle cell disease.

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.

Female infant born to a gravida II, para I, 23-year-old mother at 38 weeks' gestation. Pregnancy complicated by oligohydramnios. Cesarean delivery performed because of prolonged time after rupture of membranes and fetal distress. Apgar scores, 3 and 6 at 1 minute and 5 minutes, respectively.

What's Wrong With This Picture? Child With Appendicitis-like Symptoms

A 16-year-old girl presented with a painful rash on her hands and feet, and a sore throat. The rash, which "itched and burned," had appeared on her palms and soles a day earlier and had worsened overnight.

Some studies suggest that orally administered dapsone is effective for infections caused by spider bites (eg, brown recluse spiders) in dosages of 4 mg/kg/d for 3 days. Can dapsone be used in children and, if so, at what dosage?

I have been a pediatrician for nearly 30 years. I have practiced in affluent suburbs and in poor inner cities and have cared for patients from many religious, ethnic, and cultural backgrounds. Experience has taught me that there are certain ways to approach a child's parents that are nearly universally appreciated.

While spending a month in Cuba, my travel companion experienced seabather's eruption (Figure), which was described by Drs Mary Sy and Gary Williams in their Photo Essay "The Dermatologic Perils of Swimming" (CONSULTANT FOR PEDIATRICIANS, July/August 2004, page 333). Fortunately, some Cuban onlookers knew how to treat this condition (referred to locally as "El Caribe"). After vinegar was applied to the eruption, the pruritus and burning diminished almost immediately.

During a neurologic evaluation for seizures, a 17-year-old boy with epilepsy was noted to have a deformity of both lower eyelids. According to the boy's mother, the deformity had been present since birth; it was not related to the patient's neurologic condition.

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.

A 4-day-old boy was transferred to our institution for evaluation of multiple anomalies. He was born to a gravida 2 para 1 mother at 38 weeks of gestation. He weighed 3288 g at birth. Antenatal ultrasonograms at 5, 6, and 7 months had revealed short bones in the legs. The mother was subsequently lost to follow-up--until now.

Pneumonia is one of the most common conditions encountered by primary care providers. Certain organisms cause pneumonia in particular age groups. For example, group B streptococci, Gram-negative bacilli Escherichia coli in particular) and, rarely, Listeria monocytogenes cause pneumonia in neonates. In infants younger than 3 months, group B streptococci and organisms encountered by older children occasionally cause pneumonia, as does Chlamydia trachomatis. Older infants and preschoolers are at risk for infection with Streptococcus pneumoniae and Haemophilus influenzae. In children older than 5 years, S pneumoniae and Mycoplasma pneumoniae are the key pathogens. Let the patient's age, history, clinical presentation, and radiographic findings guide your choice of therapy. Even though most patients with uncomplicated pneumonia can be treated as outpatients, close follow-up is important. Hospitalize patients younger than 6 months and those with complications.

This 10-year-old girl presents with a 2-week history of a persistent rash around the lips.

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.