Consultant for Pediatricians Vol 5 No 1

A 5-year-old boy, who lives on a farm and routinely plays with his pet dogs, presented with these scaly, inflamed macules with a central clearingon the abdomen (A) and forehead.

An 18-year-old girl presented with an asymptomatic nodule on the posterior aspect of the right upper arm. The lesion had developed a month after an episode of chickenpox at 11 years of age and had slowly enlarged. The lesion was 7 mm in diameter; it was firm, rubbery, reddish brown, and nontender.

This lesion on the chest of a 6-week-old infant had developed over 2 days (A). It began as a small mass just below the right nipple. Initially, there was no tenderness or erythema; within 2 days, the lesion had begun to drain green-yellow and then white purulent exudate.

he parents of a 16-year-old girl report that during the past several months, she has exhibited behavioral changes, irritability, increased anger, depression, and anxiety. The girl had previously been healthy, and there has been no recent illness or trauma.

ASSESSMENT

A 15-month-old girl presents for evaluation of macrocephaly and unusual facial features. Her prenatal and natal history are unremarkable. The child is now developing normally after mild gross motor delays during the first 6 months of life. Mild scoliosis was noted on a babygram taken at 8 months during an evaluation for possible nonaccidental trauma.

I've learned (the hard way) that many parents of chronically ill children are sensitive and reliable observers of their children. What prevents physicians (at all levels of training) from failing to appreciate this fact?

A 9-year-old girl presented with these lesions on her face and extremities. The lesions, which had developed within the past 24 hours, were warm to the touch and only mildly pruritic. The child feels unwell with nonspecific complaints of malaise and lack of energy. Before this eruption, she had been healthy and had not been taking any medications.

A 10-month-old girl with a mass on left side of neck. Swelling first noticed by mother when child was 7 months old. The infant is eating well, thriving, and otherwise healthy.